=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902084791
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BINDI SHAH D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2008
-----------------------------------------------------
Last Update Date | 02/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MONTCLAIR STATE UNIVERSITY; CAPS 1 NORMAL AVE
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07043-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-655-5211
-----------------------------------------------------
Fax | 973-655-4470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | MONTCLAIR STATE UNIVERSITY 1 NORMAL AVE
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07043-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-655-5211
-----------------------------------------------------
Fax | 973-655-4470
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 25MB07211400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 25MB07211400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------