Provider Demographics
NPI:1336162015
Name:SHAH, HEMANGINI R (DO)
Entity Type:Individual
Prefix:
First Name:HEMANGINI
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841180
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1180
Mailing Address - Country:US
Mailing Address - Phone:609-978-2194
Mailing Address - Fax:609-978-2843
Practice Address - Street 1:1140 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2412
Practice Address - Country:US
Practice Address - Phone:609-978-2194
Practice Address - Fax:609-978-2843
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201282085R0001X
NJ25MB063063002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0219347Medicaid
NY02136496Medicaid
NY220128OtherNYS LICENSE
G69645Medicare UPIN
NJ0219347Medicaid
NJ175400Medicare PIN