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General NPI Number Information
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NPI Number | 1912347030
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Entity Type | Individual
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Provider Name | AMOL R SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2013
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 1060 BROAD ST STE 2A
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City | NEWARK
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State | NJ
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Zip | 07102-2321
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Country | US
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Telephone | 973-642-3155
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Fax | 973-642-0047
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Provider Business Mailing Address
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Address Line | 18 BUCHANON CT
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1126
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Country | US
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Telephone | 973-642-3155
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Fax | 973-642-0047
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA10400300
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License Number State | NJ
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