1356627277 NPI number — NRUPA SHAH DPM

Table of content: NRUPA SHAH DPM (NPI 1356627277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356627277 NPI number — NRUPA SHAH DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
NRUPA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356627277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2163 OAK TREE RD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08820-1083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-662-3050
Provider Business Mailing Address Fax Number:
732-662-3049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2163 OAK TREE RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820-1083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-662-3050
Provider Business Practice Location Address Fax Number:
732-662-3049
Provider Enumeration Date:
10/24/2011

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 25MD00311600 , 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)