Provider Demographics
NPI:1922435585
Name:SHRENIK G SHAH MD PC
Entity Type:Organization
Organization Name:SHRENIK G SHAH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRENIK
Authorized Official - Middle Name:G
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-338-8059
Mailing Address - Street 1:55 W PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4502
Mailing Address - Country:US
Mailing Address - Phone:973-338-8059
Mailing Address - Fax:973-338-6013
Practice Address - Street 1:55 W PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4502
Practice Address - Country:US
Practice Address - Phone:973-338-8059
Practice Address - Fax:973-338-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA044420261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4699106Medicaid
NJ4699106Medicaid
NJ022551Medicare PIN