Healthcare Provider Details

I. General information

NPI: 1538361290
Provider Name (Legal Business Name): MILIND NARENDRA SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GALLOPING HILL RD BUILDING K-16
KENILWORTH NJ
07033-1310
US

IV. Provider business mailing address

11 BISHOP PL
NEW BRUNSWICK NJ
08901-1178
US

V. Phone/Fax

Practice location:
  • Phone: 908-298-2835
  • Fax: 908-298-2834
Mailing address:
  • Phone: 732-516-9741
  • Fax: 732-516-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number25MA07453700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07453700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: