Provider Demographics
NPI:1558557124
Name:PRADIP S. SHAH, M.D.
Entity Type:Organization
Organization Name:PRADIP S. SHAH, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-276-3026
Mailing Address - Street 1:10 DARTMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1516
Mailing Address - Country:US
Mailing Address - Phone:973-716-0052
Mailing Address - Fax:862-702-3301
Practice Address - Street 1:459 PASSAIC AVE
Practice Address - Street 2:OAK HEALTH CENTER - CRANE'S MILL
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7457
Practice Address - Country:US
Practice Address - Phone:973-276-3026
Practice Address - Fax:973-276-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062084207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty