Basic Information
| Provider Information | |||||||||
| NPI: | 1548355720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SUMATILAL | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ALBERTSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115071034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162419126 | ||||||||
| FaxNumber: | 5166257327 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 DEKALB AVE | ||||||||
| Address2: | DOCTORS PRIVATE OFFICES | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112015425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182506915 | ||||||||
| FaxNumber: | 7182508449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 161169 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0C0698 | 01 | NY | HEALTHNET | OTHER | 719986 | 01 | NY | UNITED HEALTH | OTHER | 161169A21 | 01 | NY | HEALTH FIRST | OTHER | 43283 | 01 | NY | CIGNA PROVIDER | OTHER | BKX0209 | 01 | NY | AMERICHOICE | OTHER | 00889565 | 05 | NY | MEDICAID | 0096647 | 01 | NY | GHI PROVIDER | OTHER | 41D621 | 01 | NY | BLUECROSS | OTHER | KP451 | 01 | NY | OXFORD PROVIDER | OTHER | SS041D6210 | 01 | NY | 1199 BENEFIT FUND | OTHER | 161169 | 01 | NY | HIP | OTHER |