Healthcare Provider Details

I. General information

NPI: 1053689919
Provider Name (Legal Business Name): DENISH B SHAH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/08/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 N OLDEN AVENUE EXT
EWING NJ
08638-3206
US

IV. Provider business mailing address

1 COLONIAL CT
MONROE TOWNSHIP NJ
08831-5131
US

V. Phone/Fax

Practice location:
  • Phone: 609-588-3830
  • Fax:
Mailing address:
  • Phone: 973-460-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056371-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02832800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: