Provider Demographics
NPI:1215900774
Name:SHEHADEH, ABBAS A (MD)
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:A
Last Name:SHEHADEH
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:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-0679
Mailing Address - Country:US
Mailing Address - Phone:973-731-0203
Mailing Address - Fax:973-731-0017
Practice Address - Street 1:443 NORTHFIELD AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-731-0203
Practice Address - Fax:973-731-0017
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06090700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7059507Medicaid
NJ860251Medicare ID - Type Unspecified
NJ7059507Medicaid
NJF39118Medicare UPIN
NJ071192Medicare PIN