Provider Demographics
NPI:1821094194
Name:SHAH, SAMIR V (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:V
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5187
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:
Practice Address - Street 1:200 BOWMAN DR STE D285
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9626
Practice Address - Country:US
Practice Address - Phone:856-576-5746
Practice Address - Fax:856-519-5295
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07205600207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8622604Medicaid
NJ3321541OtherAETNA
NJ0072857000OtherAMERIHEALTH
NJ134233377OtherHORIZON
NJ134233377OtherHORIZON
NJ8622604Medicaid