Provider Demographics
NPI:1043468622
Name:SHAH, JIGNESH MAHENDRA
Entity Type:Individual
Prefix:MR
First Name:JIGNESH
Middle Name:MAHENDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2913
Mailing Address - Country:US
Mailing Address - Phone:718-542-3335
Mailing Address - Fax:718-542-3338
Practice Address - Street 1:1570 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2913
Practice Address - Country:US
Practice Address - Phone:718-542-3335
Practice Address - Fax:718-542-3338
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046596-1183500000X
NJRI-25005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist