1376550665 NPI number — AMARISH SHETH MD

Table of content: AMARISH SHETH MD (NPI 1376550665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376550665 NPI number — AMARISH SHETH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHETH
Provider First Name:
AMARISH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1376550665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1544 KUSER ROAD
Provider Second Line Business Mailing Address:
SUITE C1
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-585-2200
Provider Business Mailing Address Fax Number:
609-581-6994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1544 KUSER ROAD
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-585-2200
Provider Business Practice Location Address Fax Number:
609-581-6994
Provider Enumeration Date:
08/01/2006

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: 208000000X , with the licence number:  MA033558 , 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)

  • Identifier: 36954 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K2758 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0076083000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000219401 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20353 . This is a "UNIVERSITY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3056657 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: MEP114 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1047088 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".




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