Provider Demographics
NPI:1366839722
Name:SHAH, RUCHIR (MS OTR/L)
Entity Type:Individual
Prefix:MR
First Name:RUCHIR
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STEVEN DR
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1009
Mailing Address - Country:US
Mailing Address - Phone:516-302-5076
Mailing Address - Fax:
Practice Address - Street 1:274 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3911
Practice Address - Country:US
Practice Address - Phone:516-431-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist