Provider Demographics
NPI:1992720809
Name:BANKIM D. SHAH M.D. PA
Entity type:Organization
Organization Name:BANKIM D. SHAH M.D. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BANKIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-341-0020
Mailing Address - Street 1:19 MULE RD STE C7
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5061
Mailing Address - Country:US
Mailing Address - Phone:732-341-0020
Mailing Address - Fax:732-341-0072
Practice Address - Street 1:25 MULE RD UNIT B4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5037
Practice Address - Country:US
Practice Address - Phone:732-341-0020
Practice Address - Fax:732-341-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID #
NJ067431Medicare ID - Type UnspecifiedPROVIDER ID #