Provider Demographics
NPI:1639430754
Name:SHAH MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SHAH MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-305-0444
Mailing Address - Street 1:1330 ROUTE 206
Mailing Address - Street 2:SUITE 130-330
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1921
Mailing Address - Country:US
Mailing Address - Phone:732-305-0444
Mailing Address - Fax:
Practice Address - Street 1:1330 ROUTE 206
Practice Address - Street 2:SUITE 130-330
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-1921
Practice Address - Country:US
Practice Address - Phone:732-305-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08309300208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty