Healthcare Provider Details

I. General information

NPI: 1023118106
Provider Name (Legal Business Name): IZZAT H SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 ROUTE 22 STE 201
BRIDGEWATER NJ
08807
US

IV. Provider business mailing address

1100 WESCOTT DR STE G3
FLEMINGTON NJ
08822-4600
US

V. Phone/Fax

Practice location:
  • Phone: 908-237-4110
  • Fax:
Mailing address:
  • Phone: 908-788-1710
  • Fax: 908-788-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06570100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: