Provider Demographics
NPI:1649595877
Name:SHAH, ROHAL D
Entity Type:Individual
Prefix:DR
First Name:ROHAL
Middle Name:D
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 1:1501 ROUTE 22 W
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6507
Mailing Address - Country:US
Mailing Address - Phone:908-756-1035
Mailing Address - Fax:908-756-1035
Practice Address - Street 1:1501 ROUTE 22 W
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6507
Practice Address - Country:US
Practice Address - Phone:908-756-1035
Practice Address - Fax:908-756-1035
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051705183500000X
NJ28RI02995400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist