MEDICARE: DR. SHREYANS S SHAH D.M.D

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	1223G0001X	General Practice Dentistry	DI21609	NJ

General Provider Information

NPI Number	:	1326137423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHREYANS S SHAH D.M.D

Provider Business Mailing Address
First Line	:	157 NEWARK POMPTON TPKE
Second Line	:
City	:	PEQUANNOCK
State	:	NJ
Zip	:	07440-1300
Country	:	US
Telephone Number	:	973-696-4252
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 NEWARK POMPTON TPKE
Second Line	:
City	:	PEQUANNOCK
State	:	NJ
Zip	:	07440-1300
Country	:	US
Telephone Number	:	973-696-4252
Fax Number	:	973-872-9018

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/05/2016

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