Individual
RUTU SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5 HUDSON VALLEY PROFESSIONAL PLAZA, NEWBURGH, NY 12550
(845) 562-5570
Mailing address
138 FOLTIM WAY, CONGERS, NY 10920-1424
(845) 270-3359
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
061831
NY
1223P0221X
Pediatric Dentistry
Primary
061831
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/14/2019
Last updated
01/24/2022
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