Healthcare Provider Details

I. General information

NPI: 1497792121
Provider Name (Legal Business Name): SUNIL CHANDRA SHAH M,D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 13TH AVE
PATERSON NJ
07504-1544
US

IV. Provider business mailing address

16 GATHERING ROAD
PINEBROOK NJ
07058
US

V. Phone/Fax

Practice location:
  • Phone: 73-278-9023
  • Fax: 973-977-6761
Mailing address:
  • Phone: 973-278-9023
  • Fax: 973-977-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number29587
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: