Provider Demographics
NPI:1104911957
Name:SHAH, BHUPENDRA N (MD)
Entity type:Individual
Prefix:DR
First Name:BHUPENDRA
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 AVENUE Y
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6126
Mailing Address - Country:US
Mailing Address - Phone:718-891-6060
Mailing Address - Fax:718-891-8210
Practice Address - Street 1:739 AVENUE Y
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6126
Practice Address - Country:US
Practice Address - Phone:718-891-6060
Practice Address - Fax:718-891-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129773207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00581728Medicaid
NY343481Medicare PIN
NYCO8874Medicare UPIN