Basic Information
| Provider Information | |||||||||
| NPI: | 1427011782 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | DHIREN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3085 HARLEM RD | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142252591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445500 | ||||||||
| FaxNumber: | 7168445550 | ||||||||
| Practice Location | |||||||||
| Address1: | 3085 HARLEM ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168445500 | ||||||||
| FaxNumber: | 7168445550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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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 | 2085R0001X | 200420 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00010162602 | 01 | NY | UNIVERA | OTHER | 3708711 | 01 | NY | INDEPENDENT HEALTH | OTHER | 000523855002 | 01 | NM | BC OF WNY | OTHER | 01619878 | 05 | NY | MEDICAID |