Provider Demographics
NPI:1174044481
Name:SHWETAMBARA PARAKH MD LLC
Entity Type:Organization
Organization Name:SHWETAMBARA PARAKH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHWETAMBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-567-1919
Mailing Address - Street 1:106 GRAND AVE STE 490
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3596
Mailing Address - Country:US
Mailing Address - Phone:201-567-1919
Mailing Address - Fax:
Practice Address - Street 1:106 GRAND AVE STE 490
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3596
Practice Address - Country:US
Practice Address - Phone:201-567-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09755500208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty