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Organization

MUKESH D. SHAH, OB-GYN P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MUKESH DHIRAJLAL SHAH M.D. (OWNER / PRESIDENT)
(315) 724-4017
Entity
Organization

Contact information

Practice address
1656 CHAMPLIN AVE, SUITE # 224, UTICA, NY 13502-4830
(315) 724-4017
(315) 793-3689
Mailing address
1656 CHAMPLIN AVE, SUITE # 224, UTICA, NY 13502-4830
(315) 724-4017
(315) 793-3689

Taxonomy

Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
165131
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00796901
NY
01
AA0180
MEDICARE GROUP
NY
Enumeration date
12/18/2007
Last updated
12/18/2007
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