Provider Demographics
NPI:1093995524
Name:SHAH, KUMARPAL AMBALAL (MD)
Entity Type:Individual
Prefix:
First Name:KUMARPAL
Middle Name:AMBALAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KUMAR
Other - Middle Name:A
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:326 LIVINGSTON ST
Mailing Address - Street 2:A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1002
Mailing Address - Country:US
Mailing Address - Phone:718-222-1065
Mailing Address - Fax:718-222-1350
Practice Address - Street 1:28 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1010
Practice Address - Country:US
Practice Address - Phone:718-222-1065
Practice Address - Fax:718-222-1350
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139486207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY67A031OtherMEDICARE ID
NYP00106064OtherMEDICARE RAIL RD
NY0021517OtherGHI
NY340290101, IMOtherHEALTH PLUS
NY340300201 ENDOtherHEALTH FIRST
NY139486 B21OtherHEALTH FIRST
NY139486 NYOther1199
NY139486OtherNY LICENSE NO
NY6635785002OtherCIGNA
NY67A03OtherBLUE SHIELD
NYP2090111OtherOXFORD
NY00770576Medicaid
NY139486OtherHIP
NY26121OtherUNITED HEALTH
NY26121OtherUNITED HEALTH
NY340300201 ENDOtherHEALTH FIRST
NYP2090111OtherOXFORD