Provider Demographics
NPI:1306065156
Name:SHAH, PRAFUL M (MD)
Entity type:Individual
Prefix:DR
First Name:PRAFUL
Middle Name:M
Last Name:SHAH
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 1:571 POST LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6064
Mailing Address - Country:US
Mailing Address - Phone:732-868-0855
Mailing Address - Fax:732-868-0345
Practice Address - Street 1:2115 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-3739
Practice Address - Country:US
Practice Address - Phone:908-486-0990
Practice Address - Fax:908-925-7745
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04204000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist