Provider Demographics
NPI:1972804821
Name:SPECIALIST IN THORACIC SURGERY LLC
Entity Type:Organization
Organization Name:SPECIALIST IN THORACIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAMJI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-313-0011
Mailing Address - Street 1:96 MILLBURN AVE
Mailing Address - Street 2:STE200A
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1944
Mailing Address - Country:US
Mailing Address - Phone:973-313-0011
Mailing Address - Fax:973-763-1589
Practice Address - Street 1:96 MILLBURN AVE
Practice Address - Street 2:STE200A
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1944
Practice Address - Country:US
Practice Address - Phone:973-313-0011
Practice Address - Fax:973-763-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04588100208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty