Provider Demographics
NPI:1588631626
Name:SHAH, SHAMJI K (MD)
Entity type:Individual
Prefix:
First Name:SHAMJI
Middle Name:K
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:96 MILLBURN AVE
Mailing Address - Street 2:SUITE 200 A
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1941
Mailing Address - Country:US
Mailing Address - Phone:973-313-0011
Mailing Address - Fax:973-763-1569
Practice Address - Street 1:96 MILLBURN AVE
Practice Address - Street 2:SUITE 200 A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1944
Practice Address - Country:US
Practice Address - Phone:973-313-0011
Practice Address - Fax:973-763-1569
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA404588100208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8013802Medicaid
NJ8013802Medicaid
NJE37327Medicare UPIN