Provider Demographics
NPI:1407653090
Name:SHAH, NAISA NAIMESHKUMAR
Entity type:Individual
Prefix:
First Name:NAISA
Middle Name:NAIMESHKUMAR
Last Name:SHAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WESTERN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4311
Mailing Address - Country:US
Mailing Address - Phone:443-834-4196
Mailing Address - Fax:
Practice Address - Street 1:1336 50TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1091
Practice Address - Country:US
Practice Address - Phone:718-435-6906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052756208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation