Provider Demographics
NPI:1700970811
Name:SHAH, AJAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1650 SELWYN AVENUE
Mailing Address - Street 2:SUITE # 4-G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7628
Mailing Address - Country:US
Mailing Address - Phone:718-960-1250
Mailing Address - Fax:718-960-1230
Practice Address - Street 1:1685 MORRIS AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-960-1250
Practice Address - Fax:718-960-1230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY176519208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01277063Medicaid
NYF20777Medicare UPIN
NY14G951Medicare ID - Type Unspecified