Provider Demographics
NPI:1558359265
Name:SHETH, HANSRAJ K (MD)
Entity Type:Individual
Prefix:
First Name:HANSRAJ
Middle Name:K
Last Name:SHETH
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:P.O. BOX 1140
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:845-582-0919
Mailing Address - Fax:845-582-0922
Practice Address - Street 1:667 STONELEIGH AVE STE 302
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2455
Practice Address - Country:US
Practice Address - Phone:845-582-0919
Practice Address - Fax:845-582-0922
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228725208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2604H1Medicare ID - Type Unspecified
NYIO3783Medicare UPIN