Provider Demographics
NPI:1619162690
Name:SHAY, PHIL FARHAD (MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:FARHAD
Last Name:SHAY
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:DR
Other - First Name:FARHAD
Other - Middle Name:
Other - Last Name:SHAIKH-BAHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, DDS
Mailing Address - Street 1:30 E 60TH ST
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1008
Mailing Address - Country:US
Mailing Address - Phone:212-808-0709
Mailing Address - Fax:917-438-0885
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:SUITE 1104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:212-808-0709
Practice Address - Fax:917-438-0885
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044304-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice