MEDICARE: DR. SURAJ SHAH DO

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	207RP1001X	Pulmonary Disease Physician	25MB12586600	NJ
2	208M00000X	Hospitalist Physician	311832	NY
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	25MB12586600	NJ

General Provider Information

NPI Number	:	1336638071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURAJ SHAH DO

Provider Business Mailing Address
First Line	:	1200 E RIDGEWOOD AVE STE 303
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-689-7755
Fax Number	:	201-689-0521

Provider Business Practice Location Address
First Line	:	1200 E RIDGEWOOD AVE STE 303
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-3937
Country	:	US
Telephone Number	:	201-689-7755
Fax Number	:	201-689-0521

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

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	01/15/2026

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