Individual
VIJAY SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
444 W MAIN ST, PATCHOGUE, NY 11772-3012
(718) 204-0414
(718) 204-7470
Mailing address
17 GORDON DR, WILLISTON PARK, NY 11596-1512
(718) 204-0414
(718) 204-7470
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
200342
NY
207RH0003X
Hematology & Oncology Physician
Primary
200342
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01642713
—
NY
Enumeration date
06/10/2006
Last updated
09/27/2019
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