Provider Demographics
NPI:1730129826
Name:SHAH, SATISH P (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:P
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 1:401 CLARKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-1606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 4, SUITE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8467
Practice Address - Country:US
Practice Address - Phone:856-794-8664
Practice Address - Fax:856-794-2671
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA317832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0082708000OtherAMERIHEALTH
NJ1156715OtherHORIZON NJ HEALTH
NJ1877500Medicaid
NJ300127243OtherRAILROAD MEDICARE
NJ1156715OtherHORIZON NJ HEALTH
NJ135271Medicare PIN