Provider Demographics
NPI:1639574429
Name:SHAH, JAY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1503 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3425
Mailing Address - Country:US
Mailing Address - Phone:732-276-2494
Mailing Address - Fax:732-719-7572
Practice Address - Street 1:1503 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3425
Practice Address - Country:US
Practice Address - Phone:732-276-2494
Practice Address - Fax:732-719-7572
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ25MA10331500208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist