Healthcare Provider Details

I. General information

NPI: 1659697290
Provider Name (Legal Business Name): HAROON SHAHID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 6
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

2424 CANTERBURY LN
NORTH BRUNSWICK NJ
08902-8200
US

V. Phone/Fax

Practice location:
  • Phone: 732-897-2777
  • Fax: 732-897-3970
Mailing address:
  • Phone: 201-264-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01095639A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD449091
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA09773600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT196991
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: