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NPI Code Detail

MEDICARE: DR. CHANDRAVADAN I SHAH MD

MEDICARE:  DR. CHANDRAVADAN I SHAH  MD
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
1207V00000XObstetrics & Gynecology Physician25MA04906800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881654168
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHANDRAVADAN I SHAH MD
Provider Business Mailing Address
First Line : 101 2ND ST
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-3324
Country : US
Telephone Number : 732-363-6655
Fax Number : 732-363-6656
Provider Business Practice Location Address
First Line : 101 2ND ST
Second Line : OHI INC
City : LAKEWOOD
State : NJ
Zip : 08701-3324
Country : US
Telephone Number : 732-363-6655
Fax Number : 732-363-6656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 03/07/2023

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Directions to “ DR. CHANDRAVADAN I SHAH MD” Practice Location

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