Provider Demographics
NPI:1013103712
Name:PANKAJ SHIROLAWALA MD LLC
Entity Type:Organization
Organization Name:PANKAJ SHIROLAWALA MD LLC
Other - Org Name:DR. PANKAJ SHIROLAWALA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN - SINGLE OWNER - LLC
Authorized Official - Prefix:
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIROLAWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-442-2211
Mailing Address - Street 1:61 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4317
Mailing Address - Country:US
Mailing Address - Phone:732-442-2211
Mailing Address - Fax:732-326-0517
Practice Address - Street 1:609 AMBOY AVE STE 101
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2577
Practice Address - Country:US
Practice Address - Phone:732-442-2211
Practice Address - Fax:732-326-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07849500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ100220Medicare PIN