Individual
DR. PRAVIN SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 BRADHURST AVE, STE 700, HAWTHORNE, NY 10532-2140
(914) 593-7800
(914) 593-7881
Mailing address
PO BOX 5801, NEW YORK, NY 10087-5801
(914) 593-7880
(914) 593-7881
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
117860
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00549853
—
NY
01
—
770002078
RAIL ROAD MEDICARE
NY
01
—
97E6133641
PTAN
NY
01
—
97E613K221
PTAN
NY
01
—
97E613K222
PTAN
NY
01
—
97E613K223
PTAN
NY
Enumeration date
05/24/2005
Last updated
10/08/2008
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