Individual provider Active NPI

Mrudula S. Shah, MD

  • Hematology & Oncology Physician
  • Plainview, NY
National Provider Identifier
1982788303
Registry record updated Oct 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
143360 Issued in NY
Practice address
528 Old Country Road
Plainview, NY 11803-4997
Phone
(516) 822-4706
Fax
(516) 822-1373
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 143360 NY
Hematology & Oncology Physician 207RH0003X 143360 NY Primary

Addresses

Primary practice location

528 Old Country Road
Plainview, NY 11803-4997

Mailing address

528 Old Country Road
Plainview, NY 11803-4997
Phone (516) 822-4706

Other identifiers 1

IdentifierTypeStateIssuer
00814984MedicaidNY

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
143360NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Atm Yousuf Physician PC Internal Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mrudulashah@smgl.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286755200000",
    "number": "1982788303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "528 OLD COUNTRY ROAD",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118034997",
            "telephone_number": "516-822-4706",
            "fax_number": "516-822-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 OLD COUNTRY ROAD",
            "city": "PLAINVIEW",
            "state": "NY",
            "postal_code": "118034997",
            "telephone_number": "516-822-4706",
            "fax_number": "516-822-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "MRUDULA",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2010-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "143360",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "NY",
            "license": "143360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00814984",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainview, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.