Provider Demographics
NPI:1558360495
Name:SHAH, VIJAY P (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:P
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1724
Mailing Address - Country:US
Mailing Address - Phone:516-542-1090
Mailing Address - Fax:770-666-9097
Practice Address - Street 1:10 NATHAN D PERLMAN PLACE
Practice Address - Street 2:SUITE 12S34
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3851
Practice Address - Country:US
Practice Address - Phone:212-420-2124
Practice Address - Fax:212-420-3449
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY119384207ZP0102X, 207ZH0000X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400061684OtherNGS
NY01014216Medicaid
NY3599370211Medicare PIN
NYA400061684OtherNGS
NYC09133Medicare UPIN