Provider Demographics
NPI:1578696605
Name:NILAY SHAH MD PC
Entity Type:Organization
Organization Name:NILAY SHAH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NILAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-880-8060
Mailing Address - Street 1:255 W SPRING VALLEY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1444
Mailing Address - Country:US
Mailing Address - Phone:201-880-8060
Mailing Address - Fax:201-880-8061
Practice Address - Street 1:255 W SPRING VALLEY AVE STE 102
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1444
Practice Address - Country:US
Practice Address - Phone:201-880-8060
Practice Address - Fax:201-880-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH92670Medicare UPIN