Provider Demographics
NPI:1902035470
Name:1561 WESTCHESTER AVENUE MEDICAL OFFICES, PLLC
Entity Type:Organization
Organization Name:1561 WESTCHESTER AVENUE MEDICAL OFFICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-842-8900
Mailing Address - Street 1:1561 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2912
Mailing Address - Country:US
Mailing Address - Phone:718-842-8900
Mailing Address - Fax:718-589-7952
Practice Address - Street 1:1561 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2912
Practice Address - Country:US
Practice Address - Phone:718-842-8900
Practice Address - Fax:718-589-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty