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General NPI Number Information
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NPI Number | 1639574429
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Entity Type | Individual
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Provider Name | JAY M SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1503 SAINT GEORGES AVE
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City | COLONIA
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State | NJ
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Zip | 07067-3425
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Country | US
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Telephone | 732-276-2494
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Fax | 732-719-7572
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Provider Business Mailing Address
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Address Line | 1503 SAINT GEORGES AVE
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City | COLONIA
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State | NJ
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Zip | 07067-3425
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Country | US
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Telephone | 732-276-2494
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Fax | 732-719-7572
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 25MA10331500
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License Number State | NJ
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