Provider Demographics
NPI:1831101757
Name:SHAH, ANJALI N (MD)
Entity Type:Individual
Prefix:
First Name:ANJALI
Middle Name:N
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:CHAMANLAL
Other - Last Name:SHISHOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:310 FULLERTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3724
Mailing Address - Country:US
Mailing Address - Phone:845-563-9055
Mailing Address - Fax:845-913-9077
Practice Address - Street 1:310 FULLERTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3724
Practice Address - Country:US
Practice Address - Phone:845-563-9055
Practice Address - Fax:845-913-9077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00463679OtherRAIL ROAD MEDICARE
NY02593199Medicaid
I20891Medicare UPIN
NY1459P1Medicare PIN