Provider Demographics
NPI:1356378434
Name:SHAH, RAJAN S (MD)
Entity type:Individual
Prefix:
First Name:RAJAN
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FALCON RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039
Mailing Address - Country:US
Mailing Address - Phone:973-642-0280
Mailing Address - Fax:973-642-0047
Practice Address - Street 1:1060 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-642-0280
Practice Address - Fax:973-642-0047
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40413207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0560901Medicaid
D06420Medicare UPIN
NJ0560901Medicaid