Provider Demographics
NPI:1285734301
Name:SHAH, MAYA MEHUL (MD)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:MEHUL
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:90 FARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3007
Mailing Address - Country:US
Mailing Address - Phone:973-376-5042
Mailing Address - Fax:973-376-0366
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:AVE
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7230
Practice Address - Fax:973-926-9568
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA057717207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6245307Medicaid
NJ6245307Medicaid
004636Medicare ID - Type Unspecified