Provider Demographics
NPI:1003882523
Name:SHIROLAWALA, PANKAJ R (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:R
Last Name:SHIROLAWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:61 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4317
Mailing Address - Country:US
Mailing Address - Phone:732-326-0837
Mailing Address - Fax:732-326-0517
Practice Address - Street 1:609 AMBOY AVE STE 101
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2577
Practice Address - Country:US
Practice Address - Phone:732-442-2211
Practice Address - Fax:732-326-0517
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07849500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ20-4436194OtherQUALCARE
NJ2728989000OtherAMERIHEALTH HMO
NJ7995802OtherAETNA
NY02689307Medicaid
NJ2623898OtherUNITED HEALTHCARE
NJ0096920Medicaid
NJ20-4436194OtherGREATWEST HEALTHCARE
NJ300899OtherAMERIGROUP OF NJ
NJ91002229500OtherAMERICHOICE
NJP3719178OtherOXFORD
NJ3K3412OtherHEALTHNET
NY0645U1OtherBCBS
NJ5337019OtherCIGNA
NJ9425393OtherPHCS
NY1663S1Medicare ID - Type Unspecified
NJ099589VAAMedicare PIN
NJ2623898OtherUNITED HEALTHCARE