Provider Demographics
NPI:1992891725
Name:SHAH, NEETA MINAL (MD, FACP)
Entity type:Individual
Prefix:DR
First Name:NEETA
Middle Name:MINAL
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 COACHMAN PLACE W
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3052
Mailing Address - Country:US
Mailing Address - Phone:516-496-7368
Mailing Address - Fax:516-677-0107
Practice Address - Street 1:400 LAKEVILLE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-8625
Practice Address - Fax:718-470-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01347988Medicaid
NY01347988Medicaid
NYF16019Medicare UPIN