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General NPI Number Information
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NPI Number | 1083911598
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Entity Type | Individual
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Provider Name | HINNA EHSANULLAH SHAH M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 05/06/2020
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Provider Practice Location Address
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Address Line | 1411 BROADWAY FL 10
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City | NEW YORK
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State | NY
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Zip | 10018-3496
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Country | US
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Telephone | 732-786-3793
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Fax |
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Provider Business Mailing Address
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Address Line | 901 W MAIN ST BLDG A, SUITE 367
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 732-786-3793
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Fax | 732-845-5407
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA08883200
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License Number State | NJ
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