Provider Demographics
NPI:1053331827
Name:DR PRITESH J SHAH MD PC
Entity Type:Organization
Organization Name:DR PRITESH J SHAH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRITESH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-358-0400
Mailing Address - Street 1:354 OLD HOOK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3246
Mailing Address - Country:US
Mailing Address - Phone:201-358-0400
Mailing Address - Fax:
Practice Address - Street 1:354 OLD HOOK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3246
Practice Address - Country:US
Practice Address - Phone:201-358-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ520902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01805650Medicaid
NJ6751806Medicaid
NJF77638Medicare UPIN
NJ146529Medicare PIN