Provider Demographics
NPI:1487850269
Name:SHAHIN, ISAM M (MA,PT)
Entity Type:Individual
Prefix:
First Name:ISAM
Middle Name:M
Last Name:SHAHIN
Suffix:
Gender:M
Credentials:MA,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3706
Mailing Address - Country:US
Mailing Address - Phone:201-617-0813
Mailing Address - Fax:201-863-0944
Practice Address - Street 1:280 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-3706
Practice Address - Country:US
Practice Address - Phone:201-617-0813
Practice Address - Fax:201-863-0944
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA005770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist