Provider Demographics
NPI:1447406491
Name:SHAD PULMONARY AND CRITICAL CARE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SHAD PULMONARY AND CRITICAL CARE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUR
Authorized Official - Middle Name:RAUF
Authorized Official - Last Name:SHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-967-8425
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-0174
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:SUTIE 103
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-309-4324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07564400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ109267Medicare PIN