Provider Demographics
NPI:1467913236
Name:SHAH, ROHAN (MD)
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 60TH RD APT 6D
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5518
Mailing Address - Country:US
Mailing Address - Phone:347-837-4563
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF MEDICINE HSC LEVEL 16, SUNY STONY BROOK HOSP
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-2058
Practice Address - Fax:631-444-2493
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine