Provider Demographics
NPI:1154302024
Name:SHEN, EDRED V (MD)
Entity Type:Individual
Prefix:DR
First Name:EDRED
Middle Name:V
Last Name:SHEN
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 1:2253 SOUTH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4688
Mailing Address - Country:US
Mailing Address - Phone:908-654-1500
Mailing Address - Fax:908-654-7391
Practice Address - Street 1:2253 SOUTH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-4688
Practice Address - Country:US
Practice Address - Phone:908-654-1500
Practice Address - Fax:908-654-7391
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06695100208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G63590Medicare UPIN