Provider Demographics
NPI:1669671194
Name:SHAH, NEIL PRAVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:PRAVIN
Last Name:SHAH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CAREMOUNT MEDICAL PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1389
Practice Address - Street 1:90 S BEDFORD RD
Practice Address - Street 2:CAREMOUNT MEDICAL PC
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1389
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2017-03-24
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Provider Licenses
StateLicense IDTaxonomies
NY2507912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03588814Medicaid
NYA400096650Medicare PIN