Organization
VIJAY SHAH PHYSICIAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIJAY R SHAH MD (OWNER/PHYSICIAN)
(631) 805-2241
Entity
Organization
Contact information
Practice address
17 GORDON DR, WILLISTON PARK, NY 11596-1512
(631) 805-2241
(718) 204-7470
Mailing address
17 GORDON DR, WILLISTON PARK, NY 11596-1512
(631) 805-2241
(718) 204-7470
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
200343
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01642713
—
NY
Enumeration date
08/04/2011
Last updated
08/22/2011
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