Basic Information
| Provider Information | |||||||||
| NPI: | 1639110836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | NISHANT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 DOYLE RD | ||||||||
| Address2: | |||||||||
| City: | MATAWAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077479604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9085960556 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 E 233RD ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189209135 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 04/16/2012 | ||||||||
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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 | 207P00000X | 25MA08063900 | NJ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 247379-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.