Provider Demographics
NPI:1235494485
Name:SHAH, RENU (OD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WEST JERSEY STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202
Mailing Address - Country:US
Mailing Address - Phone:908-289-1166
Mailing Address - Fax:908-352-4752
Practice Address - Street 1:230 WEST JERSEY STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202
Practice Address - Country:US
Practice Address - Phone:908-289-1166
Practice Address - Fax:908-352-4752
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OM00107800152W00000X
NJ27OA00640800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist