Provider Demographics
NPI:1891789731
Name:SHAW, DANIEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALAN
Last Name:SHAW
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 1:541 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2107
Mailing Address - Country:US
Mailing Address - Phone:908-232-3879
Mailing Address - Fax:908-232-5789
Practice Address - Street 1:541 E BROAD ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2107
Practice Address - Country:US
Practice Address - Phone:908-232-3879
Practice Address - Fax:908-232-5789
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06274400207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0172200001OtherDMERC
0172200001OtherDMERC
F90848Medicare UPIN
0172200001OtherDMERC