Provider Demographics
NPI:1245557842
Name:SHAH, ARCHAN PRADIP (MSPT)
Entity Type:Individual
Prefix:
First Name:ARCHAN
Middle Name:PRADIP
Last Name:SHAH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5907
Mailing Address - Country:US
Mailing Address - Phone:813-774-0058
Mailing Address - Fax:718-676-9511
Practice Address - Street 1:3514 MERMAID AVE
Practice Address - Street 2:SUITE 003
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1508
Practice Address - Country:US
Practice Address - Phone:718-996-1100
Practice Address - Fax:718-676-9511
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY032358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist