Healthcare Provider Details

I. General information

NPI: 1013382548
Provider Name (Legal Business Name): PRADIP SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 GEORGES RD SUITE 2B
DAYTON NJ
08810-2436
US

IV. Provider business mailing address

495 GEORGES RD SUITE 2B
DAYTON NJ
08810-2436
US

V. Phone/Fax

Practice location:
  • Phone: 732-438-0432
  • Fax: 732-438-0472
Mailing address:
  • Phone: 732-438-0432
  • Fax: 732-438-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: