Healthcare Provider Details

I. General information

NPI: 1942388228
Provider Name (Legal Business Name): KOMAL SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 FRONTAGE RD FL 1
HAMPTON NJ
08827-4031
US

IV. Provider business mailing address

45 HARTLANDER ST
EAST BRUNSWICK NJ
08816-2668
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 732-735-5898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07231400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: