Basic Information
| Provider Information | |||||||||
| NPI: | 1487989570 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | ANKIT | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 799 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070390799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003450064 | ||||||||
| FaxNumber: | 9732511109 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 REHILL AVE | ||||||||
| Address2: | SOMERSET MEDICAL CENTER | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088762519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086852200 | ||||||||
| FaxNumber: | 9732511109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 10/08/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00226100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.