Provider Demographics
NPI:1437159407
Name:SHAH, RASESH (MD)
Entity Type:Individual
Prefix:
First Name:RASESH
Middle Name:
Last Name:SHAH
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 1:1020 KINGS HWY N STE 201
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1906
Mailing Address - Country:US
Mailing Address - Phone:856-667-1575
Mailing Address - Fax:856-946-1747
Practice Address - Street 1:620 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1795
Practice Address - Country:US
Practice Address - Phone:856-602-4000
Practice Address - Fax:856-210-2849
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07285900207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
091132ROUMedicare ID - Type Unspecified
I29981Medicare UPIN