Healthcare Provider Details

I. General information

NPI: 1083132179
Provider Name (Legal Business Name): NADIA SHAH DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 SUMMERHILL RD STE 2
EAST BRUNSWICK NJ
08816-4911
US

IV. Provider business mailing address

172 SUMMERHILL RD STE 2
EAST BRUNSWICK NJ
08816-4911
US

V. Phone/Fax

Practice location:
  • Phone: 561-271-6593
  • Fax:
Mailing address:
  • Phone: 732-944-0200
  • Fax: 732-276-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00336800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number25MD00336800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00336800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number25MD00336800
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00336800
License Number StateNJ

VIII. Authorized Official

Name: DR. NADIA SHAH
Title or Position: PRACTITIONER
Credential: DPM
Phone: 732-944-0200