Provider Demographics
NPI:1962406504
Name:SHAH, PAYAL
Entity type:Individual
Prefix:DR
First Name:PAYAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-907-0900
Mailing Address - Fax:201-907-0229
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-907-0900
Practice Address - Fax:201-907-0229
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07462300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0296694OtherGHI PPO
NJ2342746000OtherAMERIHEALTH
NJ3333547OtherAETNA HMO
NJ192604OtherAMERICAID AMERIGROUP
NJ60017889OtherHORIZON NJ HEALTH
NJ40752OtherUNIVERSITY HEALTH PLANS
NJP3170647OtherOXFORD
NJ0031330Medicaid
NJ7660480OtherAETNA PPO
NJP00168608OtherRAILROAD MEDICARE
NJ3K2381OtherHEALTHNET
NJ7660480OtherAETNA PPO
NJ3K2381OtherHEALTHNET
NJ40752OtherUNIVERSITY HEALTH PLANS