Provider Demographics
NPI:1073854113
Name:NIMISHA SHUKLA, M.D., P.A.
Entity Type:Organization
Organization Name:NIMISHA SHUKLA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMISHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHUKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-548-3210
Mailing Address - Street 1:1802 OAK TREE RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2704
Mailing Address - Country:US
Mailing Address - Phone:732-548-3210
Mailing Address - Fax:732-906-3966
Practice Address - Street 1:1802 OAK TREE RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2704
Practice Address - Country:US
Practice Address - Phone:732-548-3210
Practice Address - Fax:732-906-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06753200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty