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General NPI Number Information
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NPI Number | 1023118106
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Entity Type | Individual
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Provider Name | IZZAT H SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 1121 ROUTE 22 STE 201
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City | BRIDGEWATER
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State | NJ
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Zip | 08807
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Country | US
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Telephone | 908-237-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WESCOTT DR STE G3
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City | FLEMINGTON
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State | NJ
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Zip | 08822-4600
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Country | US
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Telephone | 908-788-1710
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Fax | 908-788-1716
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA06570100
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License Number State | NJ
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