Provider Demographics
NPI:1609187277
Name:SHAH, DHAVAL JAYANTKUMAR (PT)
Entity Type:Individual
Prefix:
First Name:DHAVAL
Middle Name:JAYANTKUMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PALM CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-4309
Mailing Address - Country:US
Mailing Address - Phone:201-238-6073
Mailing Address - Fax:
Practice Address - Street 1:2509 PARK AVE STE 2C
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5300
Practice Address - Country:US
Practice Address - Phone:908-205-8246
Practice Address - Fax:908-325-0420
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014658002251G0304X
2251X0800X
NY032263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic