Provider Demographics
NPI:1063412484
Name:SHAHI, CHANDRESHWAR N (MD, FACC)
Entity type:Individual
Prefix:DR
First Name:CHANDRESHWAR
Middle Name:N
Last Name:SHAHI
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 UNION AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3064
Mailing Address - Country:US
Mailing Address - Phone:908-864-4027
Mailing Address - Fax:908-864-4029
Practice Address - Street 1:245 UNION AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3064
Practice Address - Country:US
Practice Address - Phone:908-864-4027
Practice Address - Fax:908-864-4029
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA70799207RC0000X
NJ25MA07079900207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8342300Medicaid
NJ8342300Medicaid
NJ037503Medicare PIN