Provider Demographics
NPI:1275405730
Name:ADVANCED INTERNAL MEDICINE AND SLEEP WELLNESS CLINIC
Entity type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE AND SLEEP WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BANKIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-281-2420
Mailing Address - Street 1:5 PATRICK CT
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9051
Mailing Address - Country:US
Mailing Address - Phone:973-281-2420
Mailing Address - Fax:
Practice Address - Street 1:2066 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3727
Practice Address - Country:US
Practice Address - Phone:973-281-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty