Provider Demographics
NPI:1629389887
Name:SHAH, NIRAV SUBHASH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NIRAV
Middle Name:SUBHASH
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NIRAVKUMAR
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:475 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4229
Mailing Address - Country:US
Mailing Address - Phone:516-505-9505
Mailing Address - Fax:516-505-5202
Practice Address - Street 1:475 FRONT ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4229
Practice Address - Country:US
Practice Address - Phone:516-505-9505
Practice Address - Fax:516-505-5202
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist