Provider Demographics
NPI:1790848083
Name:SHAH, DARSHAN T (MD)
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:T
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 BROOKVILLE ROAD
Mailing Address - Street 2:DARSHAN SHAH MD MUTTONTOWN
Mailing Address - City:GLENHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:796 DREW STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4704
Practice Address - Country:US
Practice Address - Phone:718-827-7654
Practice Address - Fax:718-235-6425
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128759207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00383688Medicaid
NY10A611Medicare ID - Type Unspecified
NY00383688Medicaid