Healthcare Provider Details

I. General information

NPI: 1275603151
Provider Name (Legal Business Name): BINDOO RUGHANI-SHAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CORBETT WAY
EATONTOWN NJ
07724-2263
US

IV. Provider business mailing address

34 CORBETT WAY
EATONTOWN NJ
07724-2263
US

V. Phone/Fax

Practice location:
  • Phone: 732-722-2300
  • Fax:
Mailing address:
  • Phone: 732-722-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60406
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: