MEDICARE: MISS NILAM SHAH OPTICIAN

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	156FX1800X	Optician	TD3355	NJ

General Provider Information

NPI Number	:	1699980631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NILAM SHAH OPTICIAN

Provider Business Mailing Address
First Line	:	1516 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-1949
Country	:	US
Telephone Number	:	201-974-0401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-1949
Country	:	US
Telephone Number	:	201-974-0401
Fax Number	:

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

Provider Enumeration Date	:	05/12/2007
Last Update Date	:	07/08/2007

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