MEDICARE: DR. AMIT KIRIT SHAH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00280000	NJ

General Provider Information

NPI Number	:	1063400026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT KIRIT SHAH DPM

Provider Business Mailing Address
First Line	:	55 CASTLE POTINE BVLD
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854
Country	:	US
Telephone Number	:	908-565-0396
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 NEW BRUNSWICK AVE
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2162
Country	:	US
Telephone Number	:	732-903-2500
Fax Number	:	732-297-8421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	10/02/2012

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