Provider Demographics
NPI:1184627937
Name:SHAFI, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:SHAFI
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 1:1907 PARK AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5530
Mailing Address - Country:US
Mailing Address - Phone:908-561-2122
Mailing Address - Fax:908-561-7582
Practice Address - Street 1:1907 PARK AVE
Practice Address - Street 2:STE 102
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5530
Practice Address - Country:US
Practice Address - Phone:908-561-2122
Practice Address - Fax:908-561-7582
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA24015207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1216201Medicaid
NJ1216201Medicaid
NJ074187DVLMedicare PIN