1699163337 NPI number — DR. TRISHNA KIRIT SHAH M.D.

Table of content: DR. TRISHNA KIRIT SHAH M.D. (NPI 1699163337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699163337 NPI number — DR. TRISHNA KIRIT SHAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
TRISHNA
Provider Middle Name:
KIRIT
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:
UPADHYAY
Provider Other First Name:
TRISHNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699163337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 HOES LN W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PISCATAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08854-8021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-235-6153
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PATERSON ST STE 3100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-7827
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2015

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: 207LP3000X , with the licence number:  25MA09996700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: 54994 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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