Provider Demographics
NPI:1245208545
Name:SHAH, ILA A (MD)
Entity type:Individual
Prefix:MRS
First Name:ILA
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BRASS CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-6309
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-859-3352
Practice Address - Street 1:311 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1841
Practice Address - Country:US
Practice Address - Phone:908-859-2009
Practice Address - Fax:908-859-3352
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 381802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1710800Medicaid
NJB96885Medicare UPIN
PASH56775Medicare ID - Type Unspecified
NJ1710800Medicaid