Provider Demographics
NPI:1427021351
Name:JALALI, SHAILEN (MD)
Entity Type:Individual
Prefix:
First Name:SHAILEN
Middle Name:
Last Name:JALALI
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:PO BOX 33465
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0612
Mailing Address - Country:US
Mailing Address - Phone:888-985-2727
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:700 E TOWNSHIP LINE RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:484-458-1000
Practice Address - Fax:484-458-1001
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07859500208VP0014X
PAMD036877E208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1454762OtherAETNA
NJ54-2177172OtherHEALTH NET (TRICARE)
NJ54-2177172OtherHORIZON BLUE CROSS BLUE SHIELD
PA051051700OtherKEYSTONE MEDICARE 65
PA0012471380004Medicaid
NJ54-2177172OtherCHN
NJ1383718OtherCIGNA
NJ221914OtherUS FAMILY HEALTH PLAN
NJ54-2177172OtherPHCS (MULTIPLAN)
NJP3729064OtherOXFORD
PA0124713801OtherAMERICHOICE
NJ2814318000OtherAMERIHEALTH, KHPE, PERSONAL CHOICE
NJ50279209Medicaid
NJ54-2177172OtherPROCURA
NJ54-2177172OtherHORIZON CASUALITY
NJ54-2177172OtherFOCUS
NJ1241827OtherUNITED HEALTHCARE
NJ1241827OtherUNITED HEALTHCARE
NJ2814318000OtherAMERIHEALTH, KHPE, PERSONAL CHOICE
E98850Medicare UPIN
PA0012471380004Medicaid
NJ097948V6LMedicare PIN