Provider Demographics
NPI:1003336751
Name:SHAH, MAULIK D
Entity Type:Individual
Prefix:
First Name:MAULIK
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 HOSPITAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1129
Mailing Address - Country:US
Mailing Address - Phone:609-835-3624
Mailing Address - Fax:609-835-3628
Practice Address - Street 1:1113 HOSPITAL DR STE 203
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1129
Practice Address - Country:US
Practice Address - Phone:609-835-3624
Practice Address - Fax:609-835-3628
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11446600207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology