Healthcare Provider Details

I. General information

NPI: 1215126180
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HARTLANDER ST
EAST BRUNSWICK NJ
08816-2668
US

IV. Provider business mailing address

45 HARTLANDER ST
EAST BRUNSWICK NJ
08816-2668
US

V. Phone/Fax

Practice location:
  • Phone: 732-735-5898
  • Fax: 732-613-7197
Mailing address:
  • Phone: 732-735-5898
  • Fax: 732-613-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA072314
License Number StateNJ

VIII. Authorized Official

Name: DR. KOMAL SAURABH SHAH
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 732-735-5898