Provider Demographics
NPI:1679637441
Name:SHAH, RAJESH B (BS)
Entity Type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JEAN CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7337
Mailing Address - Country:US
Mailing Address - Phone:732-873-9081
Mailing Address - Fax:
Practice Address - Street 1:1 JEAN CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-7337
Practice Address - Country:US
Practice Address - Phone:732-873-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1679637441OtherNPI REGISTRY