1881635084 NPI number — DR. ANDREW J SHANAHAN MD

Table of content: DR. ANDREW J SHANAHAN MD (NPI 1881635084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881635084 NPI number — DR. ANDREW J SHANAHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHANAHAN
Provider First Name:
ANDREW
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
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:
1881635084
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
731 ALEXANDER ROAD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-921-7456
Provider Business Mailing Address Fax Number:
609-921-2972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
731 ALEXANDER ROAD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-921-7456
Provider Business Practice Location Address Fax Number:
609-921-2972
Provider Enumeration Date:
06/09/2006

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: 207RI0011X , with the licence number:  25MA06373200 , 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: 2905975012 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 874621 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0989950000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1481871 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60058075 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6956106 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: F10830 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P711524 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 141188 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 940913 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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