Provider Demographics
NPI:1629055637
Name:SHIH, DUEN (MD)
Entity Type:Individual
Prefix:
First Name:DUEN
Middle Name:
Last Name:SHIH
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 1:75 KEAN RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-1409
Mailing Address - Country:US
Mailing Address - Phone:973-564-8159
Mailing Address - Fax:973-453-3308
Practice Address - Street 1:600 PAVONIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2929
Practice Address - Country:US
Practice Address - Phone:973-564-8159
Practice Address - Fax:973-453-3308
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03107100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1034804Medicaid
NJ449730Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJD06485Medicare UPIN