Provider Demographics
NPI:1811033889
Name:KUMAR SHAH MD
Entity Type:Organization
Organization Name:KUMAR SHAH MD
Other - Org Name:KUMARPAL SHAH MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN IN PRACTICE
Authorized Official - Prefix:MR
Authorized Official - First Name:KUMARPAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-222-1065
Mailing Address - Street 1:304 LIVINGSTON ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1034
Mailing Address - Country:US
Mailing Address - Phone:718-222-1065
Mailing Address - Fax:215-261-1529
Practice Address - Street 1:304 LIVINGSTON ST
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1034
Practice Address - Country:US
Practice Address - Phone:718-222-1065
Practice Address - Fax:215-261-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139486207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0021517OtherGHI PROVIDER NO
NY00770576Medicaid
NY6635785002OtherCIGNA
NY139486OtherHIP PROVIDER ID NO
NY67A03OtherBLUE SHELD PROVIDER NO
NYP2090111OtherOXFORD
NY139486 B21OtherHEALTHFIRST PROVIDER ID
NY67A03OtherBLUE SHELD PROVIDER NO
NY67A03OtherBLUE SHELD PROVIDER NO
NYP2090111OtherOXFORD
NY00770576Medicaid