Provider Demographics
NPI:1548237571
Name:SHAH, TUSHAR L (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:L
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 1:2435 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6464
Mailing Address - Country:US
Mailing Address - Phone:718-220-7677
Mailing Address - Fax:718-220-7679
Practice Address - Street 1:2435 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6402
Practice Address - Country:US
Practice Address - Phone:718-220-7677
Practice Address - Fax:718-220-7679
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02258964Medicaid
G41710Medicare UPIN
NY02258964Medicaid