Provider Demographics
NPI:1154316503
Name:SHAH, PARAG JITENDRA (MD)
Entity Type:Individual
Prefix:
First Name:PARAG
Middle Name:JITENDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3952
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:804-261-4904
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2016-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2159871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
132995699OtherHORIZON HEALTHCARE OF NY
132995699OtherHUDSON HEALTH PLAN
132995699OtherHEALTHNOW
2594361OtherGHI
42026POtherHIP
NY02194750Medicaid
132995699OtherLOCAL 1199
4C0821OtherHEALTHNET OF NORTHEAST
132995699OtherFAM HEALTH PLUS(HUDSON HP
132995699OtherINDECS(ORANGE-ULSTER SCHL
14S311OtherBC/BS EMPIRE
0057865OtherGHI HMO
132995699OtherBEECH STREET NETWORK
132995699OtherCIGNA PPO
040426012109OtherFIDELIS (MEDICAID HMO)
132995699OtherLOCAL 1199
2594361OtherGHI