Provider Demographics
NPI:1275992034
Name:ENDOCRINE TECHNOLOGY, LLC
Entity Type:Organization
Organization Name:ENDOCRINE TECHNOLOGY, LLC
Other - Org Name:KUMAR SHAH, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMARPAL
Authorized Official - Middle Name:AMBALAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-302-3107
Mailing Address - Street 1:230 HILTON AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8180
Mailing Address - Country:US
Mailing Address - Phone:347-302-3107
Mailing Address - Fax:718-222-1350
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:347-302-3107
Practice Address - Fax:718-222-1350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KUMAR SHAH, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139486207RE0101X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100901000078OtherFIDELIS
NY112009OtherEMPIRE
NY340290101OtherHEALTH FIRST
NY011549885OtherMAGNACARE
NY1093995524OtherGHI
NY00770576Medicaid
NY112009OtherEMBLEM
NY67A031OtherBLUESHIELD
NYP00106364OtherMEDICARE RAILROAD
NYP2090111OtherOXFORD
NY139486OtherHIP
NYN214201OtherWELLCARE
NY193525OtherELDERPLAN
NY996181OtherNEIGHOURHOOD PLAN
NY193525OtherELDERPLAN