Healthcare Provider Details

I. General information

NPI: 1396986881
Provider Name (Legal Business Name): CHIRAG SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W PLEASANT AVE STE 334
MAYWOOD NJ
07607-1335
US

IV. Provider business mailing address

2 2ND ST APT 1205
JERSEY CITY NJ
07302-7031
US

V. Phone/Fax

Practice location:
  • Phone: 201-527-6800
  • Fax:
Mailing address:
  • Phone: 201-913-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08955100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number25MA08955100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: