Healthcare Provider Details

I. General information

NPI: 1699163337
Provider Name (Legal Business Name): TRISHNA KIRIT SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHNA UPADHYAY M.D.

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST STE 3100
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

675 HOES LN W
PISCATAWAY NJ
08854-8021
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7827
  • Fax:
Mailing address:
  • Phone: 732-235-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number25MA09996700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54994
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: