Provider Demographics
NPI:1588694335
Name:SHAH, ARVIND PUNJALAL (MD)
Entity type:Individual
Prefix:DR
First Name:ARVIND
Middle Name:PUNJALAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1272 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2234
Mailing Address - Country:US
Mailing Address - Phone:908-654-3525
Mailing Address - Fax:908-654-3541
Practice Address - Street 1:1272 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2234
Practice Address - Country:US
Practice Address - Phone:908-654-3525
Practice Address - Fax:908-654-3541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03100800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1879201Medicaid