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General NPI Number Information
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NPI Number | 1629206875
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Entity Type | Organization
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Legal Business Name | SHETAL MANSURIA MD LLC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 22 OLD SHORT HILLS RD SUITE 213
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5604
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Country | US
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Telephone | 973-535-3800
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Fax | 973-535-3808
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Provider Business Mailing Address
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Address Line | PO BOX 2107
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City | LIVINGSTON
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State | NJ
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Zip | 07039-7707
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Country | US
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Telephone | 973-535-3800
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Fax | 973-535-3808
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. SHETAL M MANSURIA
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Credential | MD
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Telephone | 973-294-2212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MA71413
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License Number State | NJ
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