Individual provider Active NPI

Anuj Shah, DMD

  • Student in an Organized Health Care Education/Training Program
  • Brooklyn, NY
National Provider Identifier
1174071385
Registry record updated Sep 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1 Brookdale PLZ
Brooklyn, NY 11212-3139
Phone
(718) 240-6552
NPI assigned
Sep 16, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NY Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1 Brookdale PLZ
Brooklyn, NY 11212-3139

Mailing address

744 Woodside Dr
Wantagh, NY 11793-1144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171212000529 CT Order and Referring Only - DentistPractitioner - Dentist 4082972559

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11905CTMDPhysical Medicine & Rehabilitation Physician

Interoperability endpoints

  • Direct secure messaging: anuj.shah@chcict.eclinicaldirectplus.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473984000000",
    "number": "1174071385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 WOODSIDE DR",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117931144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROOKDALE PLZ",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112123139",
            "telephone_number": "718-240-6552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "ANUJ",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-16",
        "last_updated": "2016-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.