Jitendra A Shah, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

124768-1 Issued in NY

Practice address

504 Medford Ave
Patchogue, NY 11772-1321

Phone

(631) 475-4646

Fax

(631) 447-5234

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487727996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721321",
            "telephone_number": "631-475-4646",
            "fax_number": "631-447-5234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 MEDFORD AVE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117721321",
            "telephone_number": "631-475-4646",
            "fax_number": "631-447-5234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "JITENDRA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "124768-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leon Serchuk, M.D.
• Suzanne Setter, LAC
• Melissa Diana Sgro, DPM
• Brian Shadbolt, PHARMD
• Girish J Shah, DDS
• Panna Shah, M.D.
• Sandeep A Shah
• Vijay Shah, MD
• Shahin Firoz Shaikh, MD
• Anthony J Shallash, MD

• Family Medicine Physician in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.