Provider Demographics
NPI:1548393150
Name:SHAH, VINAY J (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:153 SIBBALD DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2329
Mailing Address - Country:US
Mailing Address - Phone:201-307-9671
Mailing Address - Fax:718-829-9132
Practice Address - Street 1:1211 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4900
Practice Address - Country:US
Practice Address - Phone:718-828-6610
Practice Address - Fax:718-829-9132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NY166833207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine