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General NPI Number Information
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NPI Number | 1265627376
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Entity Type | Organization
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Legal Business Name | RAJAN SHAH MD PA
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 1060 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07102-2397
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Country | US
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Telephone | 973-642-0280
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Fax | 973-642-0047
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Provider Business Mailing Address
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Address Line | 95 FALCON RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4427
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Country | US
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Telephone | 973-642-0280
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Fax | 973-642-0047
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJAN S SHAH
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Credential | MD
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Telephone | 973-642-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MA40413
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License Number State | NJ
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