Provider Demographics
NPI:1518942127
Name:SHAH, AMI A (MD)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 1ST AVE
Mailing Address - Street 2:30 L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3700
Mailing Address - Country:US
Mailing Address - Phone:917-903-2762
Mailing Address - Fax:
Practice Address - Street 1:630 1ST AVE
Practice Address - Street 2:30 L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3700
Practice Address - Country:US
Practice Address - Phone:917-903-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20176312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02096564Medicaid
NY02096564Medicaid
NY975931Medicare ID - Type Unspecified