Provider Demographics
NPI:1811202633
Name:SHANTI, RABIE M (DMD, MD)
Entity Type:Individual
Prefix:
First Name:RABIE
Middle Name:M
Last Name:SHANTI
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BERGEN ST RM B-854
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2495
Mailing Address - Country:US
Mailing Address - Phone:739-972-3126
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN ST RM B-854
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:739-972-3126
Practice Address - Fax:973-972-7322
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458380204E00000X, 207Y00000X, 207YS0012X
NJ22DI02438500204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine