1659670123 NPI number — DR. TARAL JOBANPUTRA SHAH M.D.

Table of content: DR. TARAL JOBANPUTRA SHAH M.D. (NPI 1659670123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659670123 NPI number — DR. TARAL JOBANPUTRA SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
TARAL
Provider Middle Name:
JOBANPUTRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOBANPUTRA
Provider Other First Name:
TARAL
Provider Other Middle Name:
MAHENDRA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659670123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1046 BALLY BUNION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EGG HARBOR CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08215-5104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
848-667-3795
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ENGLISH CREEK AVE
Provider Second Line Business Practice Location Address:
BUILDING 800
Provider Business Practice Location Address City Name:
EGG HARBOR TOWNSHIP
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08234-5549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-407-2277
Provider Business Practice Location Address Fax Number:
609-272-6306
Provider Enumeration Date:
03/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA08816300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 25MA08816300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)