Provider Demographics
NPI:1992970578
Name:SHAH, VINNIE POOJA (MD)
Entity type:Individual
Prefix:DR
First Name:VINNIE
Middle Name:POOJA
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VINNIE
Other - Middle Name:POOJA
Other - Last Name:KATHPALIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2371 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3229
Mailing Address - Country:US
Mailing Address - Phone:203-371-0141
Mailing Address - Fax:203-371-6585
Practice Address - Street 1:1 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-2104
Practice Address - Country:US
Practice Address - Phone:908-277-8682
Practice Address - Fax:908-277-8694
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053079207W00000X
NJ25MA08916300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004001665Medicaid
CT400202615Medicare PIN