Healthcare Provider Details

I. General information

NPI: 1619906153
Provider Name (Legal Business Name): KALPANA SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 JACK MARTIN BLVD
BRICK NJ
08724-7732
US

IV. Provider business mailing address

PO BOX 366
MANASQUAN NJ
08736-0366
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-3376
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA03451800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: