Basic Information
| Provider Information | |||||||||
| NPI: | 1346439213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SUMIT | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 GALLOPING HILL RD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070837989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9084588330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 PLUM ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089012065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322201600 | ||||||||
| FaxNumber: | 7322201603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 08/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | 25MA09260500 | NJ | Y | 207W00000X | 25MA09260500 | NJ | N | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.