Healthcare Provider Details

I. General information

NPI: 1003880329
Provider Name (Legal Business Name): ASHISH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

IV. Provider business mailing address

PO BOX 23831
NEWARK NJ
07189-0001
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7185
  • Fax:
Mailing address:
  • Phone: 973-971-7185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA06499000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: