Provider Demographics
NPI:1891950770
Name:SHAH, JIGISHA TANMAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JIGISHA
Middle Name:TANMAY
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JIGISHA
Other - Middle Name:GANESHBHAI
Other - Last Name:CHAUHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:780 CEDAR LN
Mailing Address - Street 2:VALLEY HEALTH MEDICAL GROUP
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:780 CEDAR LN
Practice Address - Street 2:VALLEY HEALTH MEDICAL GROUP
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1706
Practice Address - Country:US
Practice Address - Phone:201-836-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08992800207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program