Provider Demographics
NPI:1720262413
Name:SHAH, HIMANI A (PT)
Entity Type:Individual
Prefix:
First Name:HIMANI
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3944
Mailing Address - Country:US
Mailing Address - Phone:551-200-4929
Mailing Address - Fax:
Practice Address - Street 1:11 HEDGEROW LN
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-7905
Practice Address - Country:US
Practice Address - Phone:347-462-4873
Practice Address - Fax:347-435-2111
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029415-1208100000X
NJ40QA01550900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation