Individual
DR. JITENDRA A SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
504 MEDFORD AVE, PATCHOGUE, NY 11772-1321
(631) 475-4646
(631) 447-5234
Mailing address
504 MEDFORD AVE, PATCHOGUE, NY 11772-1321
(631) 475-4646
(631) 447-5234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
124768-1
NY
Other
Enumeration date
11/15/2006
Last updated
07/08/2007
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