Provider Demographics
NPI:1750026233
Name:SHAH, SUNIL (MD)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:
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 1:275 BROADWAY
Mailing Address - Street 2:APT 203
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:201-423-5762
Mailing Address - Fax:201-915-2219
Practice Address - Street 1:355 GRAND STREET
Practice Address - Street 2:DEPARTMENT OF MEDICINE 1 EAST
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-915-2431
Practice Address - Fax:201-915-2219
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2023-03-13
Deactivation Date:2023-02-09
Deactivation Code:
Reactivation Date:2023-03-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program