Healthcare Provider Details

I. General information

NPI: 1528454147
Provider Name (Legal Business Name): LOKESH SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH ST
NEW BRUNSWICK NJ
08901-1935
US

IV. Provider business mailing address

29 ORCHID DR
PLAINSBORO NJ
08536-1968
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-7880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11986300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: