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General NPI Number Information
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NPI Number | 1154698868
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Entity Type | Individual
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Provider Name | KRUTI NAVIN SHAH O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 350 SPARTA AVE
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City | SPARTA
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State | NJ
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Zip | 07871-1120
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Country | US
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Telephone | 203-558-8016
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Fax |
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Provider Business Mailing Address
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Address Line | 88 N HILLSIDE AVE
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City | KENVIL
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State | NJ
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Zip | 07847-2584
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Country | US
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Telephone | 203-558-8016
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2841
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00637900
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License Number State | NJ
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