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General NPI Number Information
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NPI Number | 1831258607
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Entity Type | Individual
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Provider Name | DEEPAK O SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 142 PALISADE AVE STE 103
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City | JERSEY CITY
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State | NJ
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Zip | 07306-1108
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Country | US
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Telephone | 201-792-2727
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Fax | 201-653-3420
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Provider Business Mailing Address
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Address Line | PO BOX 947
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City | CLARK
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State | NJ
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Zip | 07066-0947
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Country | US
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Telephone | 201-792-2727
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Fax | 201-653-3420
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA36851
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License Number State | NJ
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