Provider Demographics
NPI:1437369063
Name:JYOTINDRA P. SHAH, M.D., INC.
Entity Type:Organization
Organization Name:JYOTINDRA P. SHAH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTINDRA
Authorized Official - Middle Name:PRATAPRAI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-8681
Mailing Address - Street 1:1026 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4224
Mailing Address - Country:US
Mailing Address - Phone:330-758-8681
Mailing Address - Fax:330-726-9350
Practice Address - Street 1:1026 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4224
Practice Address - Country:US
Practice Address - Phone:330-758-8681
Practice Address - Fax:330-726-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150750001Medicare NSC
OH9332823Medicare PIN
9332822Medicare PIN
OH9332821Medicare PIN