Provider Demographics
NPI:1134290224
Name:KANE, HARESH SHABA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARESH
Middle Name:SHABA
Last Name:KANE
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 1:3626 ROUTE 1 N
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5922
Mailing Address - Country:US
Mailing Address - Phone:609-945-3611
Mailing Address - Fax:
Practice Address - Street 1:3626 ROUTE 1 N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-945-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08159300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0138045Medicaid
NJ106875V07Medicare PIN
NJ106875ZEMEMedicare PIN
PAI67953Medicare UPIN
PA109102VEMMedicare PIN