Active NPI
Sudhir R Shah
- Pharmacist
- Staten Island, NY
National Provider Identifier
1578734562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 036299-1
- Practice address
- 2730 Arthur Kill Rd
Staten Island, NY 10309-1135 - Phone
- (718) 984-8172
- Fax
- (718) 984-9434
- NPI assigned
- Mar 18, 2008
- Last updated
- Mar 18, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 036299-1 | NY | Primary |
| Pharmacist | 183500000X | RI 01901400 | NJ |
Addresses
Primary practice location
2730 Arthur Kill Rd
Staten Island, NY 10309-1135
Mailing address
17 Agatha Dr
Edison, NJ 08817-2251
Phone (732) 287-3969
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RI 01901400 | Other | NJ | NJ BOARD OF PHARMACY |
| 036299-1 | Other | NY | NY STATE BOARD OF PHARMAC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RI 01901400 | NJ | MD | Pharmacist |
| 036299-1 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathmark Stores Inc | Past | Accepting new patients | |
| Pathmark Stores Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205798400000",
"number": "1578734562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 AGATHA DR",
"city": "EDISON",
"state": "NJ",
"postal_code": "088172251",
"telephone_number": "732-287-3969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2730 ARTHUR KILL RD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103091135",
"telephone_number": "718-984-8172",
"fax_number": "718-984-9434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "SUDHIR",
"middle_name": "R",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-18",
"last_updated": "2008-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "036299-1",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "RI 01901400",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NJ BOARD OF PHARMACY",
"identifier": "RI 01901400",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY STATE BOARD OF PHARMAC",
"identifier": "036299-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.