Provider Demographics
NPI:1407191448
Name:SHAH, SHOUNAK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHOUNAK
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 GRAND ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2260
Mailing Address - Country:US
Mailing Address - Phone:201-893-7424
Mailing Address - Fax:
Practice Address - Street 1:1115 GRAND ST APT 5B
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2260
Practice Address - Country:US
Practice Address - Phone:201-893-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA1474000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist