Healthcare Provider Details

I. General information

NPI: 1407998784
Provider Name (Legal Business Name): NRUPA SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HAMILTON AVE SAINT FRANCIS MEDICAL CENTER- DEPARTMENT OF MEDICINE
TRENTON NJ
08629-1915
US

IV. Provider business mailing address

14 RICHLAND DR
MOUNT LAUREL NJ
08054-9610
US

V. Phone/Fax

Practice location:
  • Phone: 609-599-5000
  • Fax: 609-599-6232
Mailing address:
  • Phone: 856-787-1840
  • Fax: 856-778-5676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA70200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: