Healthcare Provider Details

I. General information

NPI: 1003336751
Provider Name (Legal Business Name): MAULIK D SHAH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 STATE ROUTE 33
NEPTUNE NJ
07753-4859
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-2770
  • Fax: 732-897-3970
Mailing address:
  • Phone: 609-835-3624
  • Fax: 609-835-3628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MB11446600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: