Provider Demographics
NPI:1851330757
Name:ROOWALA, SHABBIR H (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABBIR
Middle Name:H
Last Name:ROOWALA
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 1:40 FULD ST
Mailing Address - Street 2:STE 302
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5247
Mailing Address - Country:US
Mailing Address - Phone:609-393-0067
Mailing Address - Fax:609-393-4943
Practice Address - Street 1:40 FULD ST
Practice Address - Street 2:STE 302
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-5247
Practice Address - Country:US
Practice Address - Phone:609-393-0067
Practice Address - Fax:609-393-4943
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA32182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63123Medicare UPIN
581224P3WMedicare ID - Type Unspecified