Provider Demographics
NPI:1154500304
Name:NIHALANI, SHUBHAMVADA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBHAMVADA
Middle Name:
Last Name:NIHALANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHUBHAMVADA
Other - Middle Name:
Other - Last Name:MATHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 W GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1333
Mailing Address - Country:US
Mailing Address - Phone:501-749-2262
Mailing Address - Fax:
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:CARES BUILDING 4TH FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA234035207QG0300X
NJ25MA08428200207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine