# D.K SHAH MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** GRAND STREET MEDICAL ASSOCIATES
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811243496
- **Authorized official:** MR. AMJAD KHAN (BILLING MANAGER)
- **Authorized official phone:** (845) 338-1535

## Contact information

- **Practice address:** 27 GRAND ST, KINGSTON, NY 12401-3933
- **Practice address phone:** (845) 338-1535
- **Practice address fax:** (845) 338-9879
- **Mailing address:** 27 GRAND ST, KINGSTON, NY 12401-3933
- **Mailing address phone:** (845) 338-1535
- **Mailing address fax:** (845) 338-9879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 154954 | NY | — |
| 207Q00000X | Family Medicine Physician | 208411-1 | NY | — |
| 207Q00000X | Family Medicine Physician | 233816-1 | NY | — |
| 207Q00000X | Family Medicine Physician | 238100-1 | NY | — |
| 207Q00000X | Family Medicine Physician | 238102-1 | NY | — |
| 207RG0100X | Gastroenterology Physician | 002092-1 | NY | — |
| 207RH0003X | Hematology & Oncology Physician | 123071-1 | NY | Yes |
| 207RN0300X | Nephrology Physician | 175032-1 | NY | — |
| 207RN0300X | Nephrology Physician | 220158-1 | NY | — |
| 207RN0300X | Nephrology Physician | 254731-1 | NY | — |
| 207RP1001X | Pulmonary Disease Physician | 115320-1 | NY | — |
| 207RP1001X | Pulmonary Disease Physician | 171395-1 | NY | — |
| 207W00000X | Ophthalmology Physician | 116416-1 | NY | — |

## Other

- **Enumeration date:** 08/01/2012
- **Last updated:** 08/01/2012