MEDICARE: SHAMJI K SHAH MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	25MA404588100	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1588631626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMJI K SHAH MD

Provider Business Mailing Address
First Line	:	96 MILLBURN AVE
Second Line	:	SUITE 200 A
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1941
Country	:	US
Telephone Number	:	973-313-0011
Fax Number	:	973-763-1569

Provider Business Practice Location Address
First Line	:	96 MILLBURN AVE
Second Line	:	SUITE 200 A
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1944
Country	:	US
Telephone Number	:	973-313-0011
Fax Number	:	973-763-1569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	01/13/2011

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