Basic Information
| Provider Information | |||||||||
| NPI: | 1427021351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JALALI | ||||||||
| FirstName: | SHAILEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1030 KINGS HWY N | ||||||||
| Address2: | STE 200 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080341907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889852727 | ||||||||
| FaxNumber: | 8567790211 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 E TOWNSHIP LINE RD | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | HAVERTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190835733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844581000 | ||||||||
| FaxNumber: | 4844581001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | MD036877E | PA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 208VP0014X | 25MA07859500 | NJ | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1383718 | 01 | NJ | CIGNA | OTHER | 221914 | 01 | NJ | US FAMILY HEALTH PLAN | OTHER | 54-2177172 | 01 | NJ | FOCUS | OTHER | 54-2177172 | 01 | NJ | HORIZON BLUE CROSS BLUE SHIELD | OTHER | 0124713801 | 01 | PA | AMERICHOICE | OTHER | 051051700 | 01 | PA | KEYSTONE MEDICARE 65 | OTHER | 54-2177172 | 01 | NJ | CHN | OTHER | 54-2177172 | 01 | NJ | HORIZON CASUALITY | OTHER | 2814318000 | 01 | NJ | AMERIHEALTH, KHPE, PERSONAL CHOICE | OTHER | 1454762 | 01 | NJ | AETNA | OTHER | 54-2177172 | 01 | NJ | PHCS (MULTIPLAN) | OTHER | 0012471380004 | 05 | PA | MEDICAID | 1241827 | 01 | NJ | UNITED HEALTHCARE | OTHER | 50279209 | 05 | NJ | MEDICAID | 54-2177172 | 01 | NJ | PROCURA | OTHER | P3729064 | 01 | NJ | OXFORD | OTHER | 54-2177172 | 01 | NJ | HEALTH NET (TRICARE) | OTHER |