Provider Demographics
NPI:1902041643
Name:SHAH, SOORAJ M
Entity Type:Individual
Prefix:DR
First Name:SOORAJ
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CENTRE ST STE 307
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4554
Mailing Address - Country:US
Mailing Address - Phone:212-334-3507
Mailing Address - Fax:646-365-0469
Practice Address - Street 1:139 CENTRE ST STE 307
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4554
Practice Address - Country:US
Practice Address - Phone:212-334-3507
Practice Address - Fax:646-365-0469
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276483207RA0002X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease