Basic Information
| Provider Information | |||||||||
| NPI: | 1043657042 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | NEEL | ||||||||
| MiddleName: | AMAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 W BROADWAY APT 5166 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908029443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104189359 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1050 LINDEN AVE | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908133321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624919761 | ||||||||
| FaxNumber: | 5624919264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | BP20049759 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208600000X | BP10046925 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 207P00000X | 148775 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 148775 | 01 | CA | MEDICAL BOARD OF CALIFORNIA STATE LICENSE | OTHER | FS6749292 | 01 | DEA | OTHER |