Provider Demographics
NPI:1871674051
Name:SHAH, NIMESH KESHARICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMESH
Middle Name:KESHARICHARD
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20507 HILLSIDE AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2220
Mailing Address - Country:US
Mailing Address - Phone:718-464-6700
Mailing Address - Fax:718-334-3432
Practice Address - Street 1:20507 HILLSIDE AVE STE 12
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423
Practice Address - Country:US
Practice Address - Phone:718-464-6700
Practice Address - Fax:718-464-8100
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232109207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid