Provider Demographics
NPI:1578666764
Name:SHAH, HIMANSHU PANALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMANSHU
Middle Name:PANALAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:96 MILLBURN AVE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1944
Mailing Address - Country:US
Mailing Address - Phone:973-763-6800
Mailing Address - Fax:973-763-1255
Practice Address - Street 1:96 MILLBURN AVE
Practice Address - Street 2:SUITE 200A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1944
Practice Address - Country:US
Practice Address - Phone:973-763-6800
Practice Address - Fax:973-763-1255
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05574700207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6484808Medicaid
NJF70408Medicare UPIN
NJSH654888Medicare ID - Type Unspecified
NJ654888CM4Medicare PIN