Provider Demographics
NPI:1720299340
Name:SHAH, NIRAV N (DO)
Entity type:Individual
Prefix:
First Name:NIRAV
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 160, CN 5050
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-577-0600
Mailing Address - Fax:732-577-6332
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 160, CN 5050
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-577-0600
Practice Address - Fax:732-577-6332
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08017800207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6932758OtherAETNA HEALTH PLANS HMO
NJP00801247OtherMEDICARE RAILROAD CARRIER
NJ0157481Medicaid
NJP00746572OtherRR MEDICARE
NJ9958326OtherAETNA HEALTH PLANS PPO
NJ123065AH0Medicare PIN