Provider Demographics
NPI:1609194166
Name:SHAH, MAULIK V
Entity Type:Individual
Prefix:MR
First Name:MAULIK
Middle Name:V
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-1341
Mailing Address - Country:US
Mailing Address - Phone:732-586-9990
Mailing Address - Fax:718-302-4851
Practice Address - Street 1:56 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-1341
Practice Address - Country:US
Practice Address - Phone:732-586-9990
Practice Address - Fax:718-302-4851
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-08
Last Update Date:2010-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist