Provider Demographics
NPI:1689728040
Name:SHAH, DILIP AMRYTLAL (MD)
Entity Type:Individual
Prefix:
First Name:DILIP
Middle Name:AMRYTLAL
Last Name:SHAH
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 1:1033 CLIFTON AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3525
Mailing Address - Country:US
Mailing Address - Phone:973-471-8888
Mailing Address - Fax:007-253-2218
Practice Address - Street 1:1033 CLIFTON AVE STE 209
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3525
Practice Address - Country:US
Practice Address - Phone:973-471-8888
Practice Address - Fax:800-725-3221
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA419832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SH453212Medicare ID - Type Unspecified
A63029Medicare UPIN