Provider Demographics
NPI:1114431483
Name:SHAH, PURVI (OD)
Entity Type:Individual
Prefix:DR
First Name:PURVI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AMHERST CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4559
Mailing Address - Country:US
Mailing Address - Phone:732-763-9550
Mailing Address - Fax:
Practice Address - Street 1:775 ROUTE 1 STE 13
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4681
Practice Address - Country:US
Practice Address - Phone:732-623-2129
Practice Address - Fax:732-572-3087
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00677100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist