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General NPI Number Information
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NPI Number | 1003032806
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Entity Type | Organization
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Legal Business Name | ELITE INTERNAL MEDICINE, P.A.
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 601 HAMILTON AVE
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City | TRENTON
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State | NJ
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Zip | 08629-1915
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Country | US
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Telephone | 609-599-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 90 ALEXANDER AVE
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City | HAMILTON
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State | NJ
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Zip | 08619-1212
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Country | US
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Telephone | 609-433-1255
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Fax |
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Authorized Official
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Title or Position | CORPORATE PRESIDENT
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Name | DR. SHAZIA SHAH
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Credential | D.O.
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Telephone | 609-433-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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