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General NPI Number Information
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NPI Number | 1497784094
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Entity Type | Individual
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Provider Name | HETAL S SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 777 ROUTE 70 EAST SUTIE G-101
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City | MARLTON
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State | NJ
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Zip | 08053-2345
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Country | US
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Telephone | 856-983-9939
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Fax | 856-983-9936
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Provider Business Mailing Address
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Address Line | 777 ROUTE 70 EAST SUITE G-101
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City | MARLTON
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State | NJ
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Zip | 08053-2345
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Country | US
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Telephone | 856-983-9939
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Fax | 856-983-9936
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA075031
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA07503100
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License Number State | NJ
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