Individual
DR. JESAL VIRENDRA SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D., MD
Contact information
Practice address
3915 BROADWAY, NEW YORK, NY 10032-1565
(212) 567-5536
(212) 202-6447
Mailing address
3915 BROADWAY, NEW YORK, NY 10032-1565
(212) 567-5536
(212) 202-6447
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
052986
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
052986-1
NY
Other
Enumeration date
10/22/2008
Last updated
12/13/2013
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