Healthcare Provider Details

I. General information

NPI: 1114121175
Provider Name (Legal Business Name): PRITESH J SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 OLD HOOK RD SUITE 102
WESTWOOD NJ
07675-3246
US

IV. Provider business mailing address

707 CALUSA TRL
FRANKLIN LAKES NJ
07417-2901
US

V. Phone/Fax

Practice location:
  • Phone: 201-358-0400
  • Fax: 201-358-6114
Mailing address:
  • Phone: 201-358-0400
  • Fax: 201-358-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number52090
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: