Provider Demographics
NPI:1760496152
Name:SHAH, SYED M (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
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:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-0505
Mailing Address - Country:US
Mailing Address - Phone:201-295-1988
Mailing Address - Fax:201-295-0266
Practice Address - Street 1:435 59TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2107
Practice Address - Country:US
Practice Address - Phone:201-295-1988
Practice Address - Fax:201-295-0266
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA057809208100000X
NJ25MA05780900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7323000Medicaid
NJ7323000Medicaid
F29988Medicare UPIN