Healthcare Provider Details

I. General information

NPI: 1154372621
Provider Name (Legal Business Name): NILAY RAMESH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W SPRING VALLEY AVE STE 102
MAYWOOD NJ
07607-1444
US

IV. Provider business mailing address

255 W SPRING VALLEY AVE STE 102
MAYWOOD NJ
07607-1444
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-8060
  • Fax: 201-301-8892
Mailing address:
  • Phone: 201-880-8060
  • Fax: 201-880-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number227852
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: