Provider Demographics
NPI:1841318672
Name:SHAH, PANKAJ (PT)
Entity type:Individual
Prefix:
First Name:PANKAJ
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SUNFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-3003
Mailing Address - Country:US
Mailing Address - Phone:609-689-0800
Mailing Address - Fax:609-689-0567
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1946
Practice Address - Country:US
Practice Address - Phone:609-689-0800
Practice Address - Fax:609-689-0567
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00250700171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00250700OtherPHYSICAL THERAPIST