Provider Demographics
NPI:1790960920
Name:SHAH, MUBINA (MD)
Entity Type:Individual
Prefix:DR
First Name:MUBINA
Middle Name:
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 68
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-0068
Mailing Address - Country:US
Mailing Address - Phone:908-300-2453
Mailing Address - Fax:732-641-2273
Practice Address - Street 1:382 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPOTSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08884-1246
Practice Address - Country:US
Practice Address - Phone:732-387-2414
Practice Address - Fax:732-698-7466
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07716100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053368Medicaid
NJ084460ZCLFMedicare PIN