=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306065156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRAFUL M SHAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 02/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2115 N WOOD AVE
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-486-0990
-----------------------------------------------------
Fax | 908-925-7745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 571 POST LN
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-6064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-868-0855
-----------------------------------------------------
Fax | 732-868-0345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MA04204000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------