1720299340 NPI number — NIRAV N SHAH DO

Table of content: NIRAV N SHAH DO (NPI 1720299340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720299340 NPI number — NIRAV N SHAH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
NIRAV
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1720299340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 160, CN 5050
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-2537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-577-0600
Provider Business Mailing Address Fax Number:
732-577-6332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 160, CN 5050
Provider Business Practice Location Address City Name:
FREEHOLD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07728-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-577-0600
Provider Business Practice Location Address Fax Number:
732-577-6332
Provider Enumeration Date:
05/25/2007

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: 207RP1001X , with the licence number:  25MB08017800 , 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: 6932758 . This is a "AETNA HEALTH PLANS HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00801247 . This is a "MEDICARE RAILROAD CARRIER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0157481 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00746572 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9958326 . This is a "AETNA HEALTH PLANS PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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