Provider Demographics
NPI:1912969379
Name:SHAHBANDI, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:SHAHBANDI
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 1:1 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:1515 BROAD ST STE B120
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3059
Practice Address - Country:US
Practice Address - Phone:973-873-7000
Practice Address - Fax:973-743-8943
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA76499208800000X
NJ25MA07649900208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K4036OtherHEALTHNET#
NJ8J4761OtherEMPIRE BCBS (WAYNE)
NJP3011050OtherOXFORD#
NJ2425466000OtherAMERIHEALTH#
NJ7291254OtherAETNA PPO#
NJ0124890OtherGHI PPO
NJ1323475OtherAETNA HMO#
NJ398325OtherWELLCARE#
NJ8J4751OtherEMPIRE BCBS (CLIFTON)
NJ8J4752OtherEMPIRE BCBS (W. PATERSON)
NJ7291254OtherAETNA PPO#
NJ8J4752OtherEMPIRE BCBS (W. PATERSON)
NJ074819BJLMedicare PIN