Healthcare Provider Details

I. General information

NPI: 1427033406
Provider Name (Legal Business Name): SHITAL V MANI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHITAL V SHAH O.D.

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N GILBERT ST STE 200
TINTON FALLS NJ
07701-4951
US

IV. Provider business mailing address

21 N GILBERT ST STE 200
TINTON FALLS NJ
07701-4951
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-1902
  • Fax:
Mailing address:
  • Phone: 732-741-1902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OM00107700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: