Healthcare Provider Details

I. General information

NPI: 1104805845
Provider Name (Legal Business Name): OHM SHIVAY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 UNION HILL RD
MANALAPAN NJ
07726-1875
US

IV. Provider business mailing address

345 UNION HILL RD
MANALAPAN NJ
07726-1875
US

V. Phone/Fax

Practice location:
  • Phone: 732-536-4705
  • Fax:
Mailing address:
  • Phone: 732-536-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00590800
License Number StateNJ

VIII. Authorized Official

Name: MR. AJAY PATEL
Title or Position: MANAGER
Credential: R.P.
Phone: 732-536-4705