Provider Demographics
NPI:1104863208
Name:SHAH, HEMANT (MD)
Entity Type:Individual
Prefix:
First Name:HEMANT
Middle Name:
Last Name:SHAH
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 1:237 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3058
Mailing Address - Country:US
Mailing Address - Phone:201-420-7373
Mailing Address - Fax:201-795-0606
Practice Address - Street 1:237 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3058
Practice Address - Country:US
Practice Address - Phone:201-420-7373
Practice Address - Fax:201-795-0606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA039176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0762008Medicaid
NJD20054Medicare UPIN
NJ0762008Medicaid