Provider Demographics
NPI:1912347030
Name:SHAH, AMOL R (MD)
Entity Type:Individual
Prefix:
First Name:AMOL
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18 BUCHANON CT
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1126
Mailing Address - Country:US
Mailing Address - Phone:973-642-3155
Mailing Address - Fax:973-642-0047
Practice Address - Street 1:1060 BROAD ST STE 2A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2321
Practice Address - Country:US
Practice Address - Phone:973-642-3155
Practice Address - Fax:973-642-0047
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2020-08-05
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10400300207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology