1639359300 NPI number — MEHUL N SHAH MD PA

Table of content: (NPI 1639359300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639359300 NPI number — MEHUL N SHAH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEHUL N SHAH MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1639359300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 MILLBURN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLBURN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07041-1943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-376-2121
Provider Business Mailing Address Fax Number:
973-467-0150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 FARBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORT HILLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07078-3007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-376-2121
Provider Business Practice Location Address Fax Number:
973-467-0150
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
MEHUL
Authorized Official Middle Name:
N
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
973-376-2121

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  25MA04839600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 25MA04839600 , 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: 4590007 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com