Provider Demographics
NPI:1659626489
Name:D.K SHAH MD PC
Entity Type:Organization
Organization Name:D.K SHAH MD PC
Other - Org Name:GRAND STREET MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMJAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-338-1535
Mailing Address - Street 1:368 BROADWAY
Mailing Address - Street 2:MEDICAL ARTS BUILDING , SUITE301
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5144
Mailing Address - Country:US
Mailing Address - Phone:845-338-1535
Mailing Address - Fax:845-338-9879
Practice Address - Street 1:368 BROADWAY
Practice Address - Street 2:MEDICAL ARTS BUILDING , SUITE301
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5144
Practice Address - Country:US
Practice Address - Phone:845-338-1535
Practice Address - Fax:845-338-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252903-1207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty