Provider Demographics
NPI:1700899259
Name:SHAH, AYAZ A (DC)
Entity Type:Individual
Prefix:
First Name:AYAZ
Middle Name:A
Last Name:SHAH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SENECA LN
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4448
Mailing Address - Country:US
Mailing Address - Phone:609-298-7141
Mailing Address - Fax:609-298-2848
Practice Address - Street 1:3722 88TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7631
Practice Address - Country:US
Practice Address - Phone:718-507-9878
Practice Address - Fax:718-507-9894
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101484111N00000X
NJ38MC00603700111N00000X
NY010484111NN0400X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation