MEDICARE: SHAH ENTERPRISE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy	28RS00505300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2056892	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275696890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAH ENTERPRISE INC

Provider Business Mailing Address
First Line	:	1019 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5511
Country	:	US
Telephone Number	:	201-865-0844
Fax Number	:	201-865-1003

Provider Business Practice Location Address
First Line	:	1019 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-5511
Country	:	US
Telephone Number	:	201-865-0844
Fax Number	:	201-865-1003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUBODH SHAH
Credential	:
Telephone Number	:	201-865-0844

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/02/2019

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Directions to “SHAH ENTERPRISE INC ” Practice Location

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