Provider Demographics
NPI:1255348587
Name:SHAH, DINA B (MD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:B
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:35-37 PROGRESS STREET
Mailing Address - Street 2:STE AA5
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:908-753-0100
Mailing Address - Fax:908-668-0777
Practice Address - Street 1:35-37 PROGRESS STREET
Practice Address - Street 2:STE AA5
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-753-0100
Practice Address - Fax:908-668-0777
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA033678002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
86877OtherPHCS
P44285496OtherMULTIPLAN
NJ3757005Medicaid
P1222755OtherOXFORD
60198OtherCIGNA
010033678NJ01OtherANTHEM
0111944000OtherAMERIHEALTH
061511OtherMAGELLAN
050882OtherVALUE OPTION
3196609OtherGHI BMP
P44285496OtherMULTIPLAN
D06806Medicare UPIN