Healthcare Provider Details

I. General information

NPI: 1669959623
Provider Name (Legal Business Name): DHAVAL NITIN SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 03/23/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WESTCOTT DRIVE SUITE G3
FLEMINGTON NJ
08822
US

IV. Provider business mailing address

1100 WESCOTT DR STE G3
FLEMINGTON NJ
08822-4600
US

V. Phone/Fax

Practice location:
  • Phone: 908-300-4494
  • Fax:
Mailing address:
  • Phone: 908-788-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA11453800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11453800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: