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NPI Code Detail

MEDICARE: DR. KAMALESH R SHAH M.D.

MEDICARE: DR. KAMALESH R SHAH 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
1207R00000XInternal Medicine PhysicianMA056894NJ
2207R00000XInternal Medicine Physician25MA05689400NJ

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 : 1891780912
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAMALESH R SHAH M.D.
Provider Business Mailing Address
First Line : 9225 KENNEDY BLVD
Second Line :
City : NORTH BERGEN
State : NJ
Zip : 07047-5361
Country : US
Telephone Number : 201-453-2800
Fax Number :
Provider Business Practice Location Address
First Line : 9225 KENNEDY BLVD
Second Line :
City : NORTH BERGEN
State : NJ
Zip : 07047-5361
Country : US
Telephone Number : 201-453-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 11/30/2016

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