Healthcare Provider Details

I. General information

NPI: 1073554879
Provider Name (Legal Business Name): JOSHUA R SHUA-HAIM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ROUTE 70 UNIT C-3
MANCHESTER NJ
08759-5806
US

IV. Provider business mailing address

1043 ROUTE 70 UNIT C-3
MANCHESTER NJ
08759-5806
US

V. Phone/Fax

Practice location:
  • Phone: 732-657-6100
  • Fax: 732-657-0111
Mailing address:
  • Phone: 732-657-6100
  • Fax: 732-657-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA05837900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: