Provider Demographics
NPI:1235455098
Name:PRADIP A. SHAH, M.D. P.C.
Entity Type:Organization
Organization Name:PRADIP A. SHAH, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-635-0050
Mailing Address - Street 1:1964 OAK TREE RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2016
Mailing Address - Country:US
Mailing Address - Phone:732-635-0050
Mailing Address - Fax:732-635-0051
Practice Address - Street 1:1964 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2016
Practice Address - Country:US
Practice Address - Phone:732-635-0050
Practice Address - Fax:732-635-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05755100207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ177767Medicare PIN