Healthcare Provider Details

I. General information

NPI: 1891613238
Provider Name (Legal Business Name): SAMARTH KETANKUMAR SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 POCONO RD
DENVILLE NJ
07834-2954
US

IV. Provider business mailing address

2435 SW 22ND AVE APT 203
DELRAY BEACH FL
33445-7727
US

V. Phone/Fax

Practice location:
  • Phone: 973-625-6000
  • Fax:
Mailing address:
  • Phone: 352-709-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: