Healthcare Provider Details

I. General information

NPI: 1619315223
Provider Name (Legal Business Name): MIHIR J SHAH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIHIR SHAH PSY.D.

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 ROUTE 33 SUITE 9-10
NEPTUNE NJ
07753-6102
US

IV. Provider business mailing address

2100 ROUTE 33 SUITE 9 & 10
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-3441
  • Fax:
Mailing address:
  • Phone: 732-988-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: