Provider Demographics
NPI:1730251810
Name:SUHAIL SHAH MD PC
Entity type:Organization
Organization Name:SUHAIL SHAH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUHAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-292-6642
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-0441
Mailing Address - Country:US
Mailing Address - Phone:516-292-6642
Mailing Address - Fax:516-292-2558
Practice Address - Street 1:1483 BEECH LN
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-3706
Practice Address - Country:US
Practice Address - Phone:516-292-6642
Practice Address - Fax:516-292-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG55631Medicare UPIN
NY38X152Medicare ID - Type Unspecified