Healthcare Provider Details

I. General information

NPI: 1922217199
Provider Name (Legal Business Name): SHOBHANA B VORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDNA MAHAN CORRECTIONAL FACILITY 30 PITTSTOWN RD
CLINTON NJ
08809
US

IV. Provider business mailing address

9 PUDDINGSTONE WAY
FLORHAM PARK NJ
07932-2624
US

V. Phone/Fax

Practice location:
  • Phone: 908-735-7111
  • Fax: 908-735-6379
Mailing address:
  • Phone: 973-822-1335
  • Fax: 973-822-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA02781800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: