Provider Demographics
NPI:1114121175
Name:SHAH, PRITESH J (MD)
Entity Type:Individual
Prefix:DR
First Name:PRITESH
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:707 CALUSA TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2901
Mailing Address - Country:US
Mailing Address - Phone:201-358-0400
Mailing Address - Fax:201-358-6114
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:201-358-6114
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ520902084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ457759Medicare ID - Type Unspecified
NJF77638Medicare UPIN