Provider Demographics
NPI:1609899632
Name:SHAH, BANKIM D (MD)
Entity Type:Individual
Prefix:
First Name:BANKIM
Middle Name:D
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MULE RD UNIT B4
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5037
Mailing Address - Country:US
Mailing Address - Phone:732-341-0020
Mailing Address - Fax:732-341-0072
Practice Address - Street 1:25 MULE RD UNIT B4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5037
Practice Address - Country:US
Practice Address - Phone:732-341-0020
Practice Address - Fax:732-341-0072
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03582500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
067431OtherMEDICARE PROVIDER #
NJD06350Medicare UPIN
NJ421276RHCMedicare ID - Type Unspecified