Provider Demographics
NPI:1073554879
Name:SHUA-HAIM, JOSHUA R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:R
Last Name:SHUA-HAIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 ROUTE 70 UNIT C-3
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5806
Mailing Address - Country:US
Mailing Address - Phone:732-657-6100
Mailing Address - Fax:732-657-0111
Practice Address - Street 1:1043 ROUTE 70 UNIT C-3
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5806
Practice Address - Country:US
Practice Address - Phone:732-657-6100
Practice Address - Fax:732-657-0111
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05837900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6083307Medicaid
NJ408439Medicare ID - Type Unspecified
NJ6083307Medicaid