Healthcare Provider Details

I. General information

NPI: 1760177604
Provider Name (Legal Business Name): SHRUTI SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROBERT WOOD JOHNSON PL
NEW BRUNSWICK NJ
08901-1928
US

IV. Provider business mailing address

14 DOGWOOD DR
EDISON NJ
08820-1445
US

V. Phone/Fax

Practice location:
  • Phone: 732-828-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MB13149600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: