Provider Demographics
NPI:1699860767
Name:SHAH, NIRAV (PT)
Entity Type:Individual
Prefix:
First Name:NIRAV
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 I U WILLETS RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3038
Mailing Address - Country:US
Mailing Address - Phone:516-270-5527
Mailing Address - Fax:516-908-5441
Practice Address - Street 1:3249 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1923
Practice Address - Country:US
Practice Address - Phone:718-224-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026046-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03169660Medicaid
NYQ22Z91Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY07395HMedicare ID - Type UnspecifiedGHI MEDICARE
NY03169660Medicaid