Healthcare Provider Details

I. General information

NPI: 1134448780
Provider Name (Legal Business Name): KISHORI SHAH MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 POST LN
SOMERSET NJ
08873-6064
US

IV. Provider business mailing address

571 POST LN
SOMERSET NJ
08873-6064
US

V. Phone/Fax

Practice location:
  • Phone: 908-581-0743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KISHORI SHAH
Title or Position: OWNER
Credential: MD
Phone: 908-581-0743