Provider Demographics
NPI:1407670649
Name:SHETH, RAJ
Entity type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:SHETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 E 83RD ST APT 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-4270
Mailing Address - Country:US
Mailing Address - Phone:817-808-8439
Mailing Address - Fax:
Practice Address - Street 1:726 BROADWAY STE 350
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-9616
Practice Address - Country:US
Practice Address - Phone:212-443-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029-367124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist