Provider Demographics
NPI:1073186995
Name:SHAH, ANISH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANISH
Middle Name:KUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 WALTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8964
Mailing Address - Country:US
Mailing Address - Phone:718-521-9479
Mailing Address - Fax:
Practice Address - Street 1:1070 WALTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8964
Practice Address - Country:US
Practice Address - Phone:718-521-9479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program