Individual
GOPAL SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
33 DELAWARE ST, PORT JERVIS, NY 12771-1805
(845) 856-5765
(845) 856-2535
Mailing address
20 GRAND STREET, 3RD FL, WARWICK, NY 10990-1035
(845) 856-5765
(845) 898-7597
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
158750
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01009067
—
NY
01
—
010158750NY01
ANTHEM PLAN
NY
01
—
117350
MVP HMO
NY
01
—
14162
GHI HMO
NY
01
—
141692539
EMPIRE PLAN
NY
05
—
1573920
—
PA
01
—
33936
AETNA HEALTH CARE
NY
01
—
632227
UNITED HEALTH
NY
01
—
72D011
BLUE CHOICE HMO
NY
01
—
P480818
OXFORD HEALTH PLAN
NY
Enumeration date
08/02/2006
Last updated
12/18/2019
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