Provider Demographics
NPI:1104889484
Name:JAY H AND VIJAYA J SHAH MD
Entity type:Organization
Organization Name:JAY H AND VIJAYA J SHAH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-322-9292
Mailing Address - Street 1:862 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1005
Mailing Address - Country:US
Mailing Address - Phone:215-322-9292
Mailing Address - Fax:215-322-4394
Practice Address - Street 1:2562 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3400
Practice Address - Country:US
Practice Address - Phone:215-244-6363
Practice Address - Fax:215-244-6365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY H AND VIJAYA J SHAH MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-08
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010343440006Medicaid
PA0423947002OtherIBC-HMO
PA0008385670005Medicaid
PA1017977OtherKEY STONE MERCY-PA
PA065174Medicare ID - Type UnspecifiedJAY H. SHAH MD
PAC29702Medicare UPIN
PA0423947002OtherIBC-HMO
PA0010343440006Medicaid