Healthcare Provider Details

I. General information

NPI: 1376452565
Provider Name (Legal Business Name): PRAX MEDICAL NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 S ORANGE AVE #2147
NEWARK NJ
07103
US

IV. Provider business mailing address

2108 N ST # 10310
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 312-798-9350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK SHEN
Title or Position: CEO & PRESIDENT
Credential:
Phone: 512-779-7276