Provider Demographics
NPI:1760546352
Name:PROFESSIONAL ASSOCIATES OF JACKSON LLC
Entity Type:Organization
Organization Name:PROFESSIONAL ASSOCIATES OF JACKSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-367-7575
Mailing Address - Street 1:2105 W COUNTY LINE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2301
Mailing Address - Country:US
Mailing Address - Phone:732-367-7575
Mailing Address - Fax:732-364-0600
Practice Address - Street 1:2105 W COUNTY LINE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2301
Practice Address - Country:US
Practice Address - Phone:732-367-7575
Practice Address - Fax:732-364-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty