Provider Demographics
NPI:1497246219
Name:SHAH, VIKAS M (DO)
Entity type:Individual
Prefix:DR
First Name:VIKAS
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 HILLTOP BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2832
Mailing Address - Country:US
Mailing Address - Phone:732-947-6805
Mailing Address - Fax:
Practice Address - Street 1:647 ROUTE 18 STE A
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3747
Practice Address - Country:US
Practice Address - Phone:732-487-3210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10932900207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine