Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA06570100 | NJ |
NPI | 1023118106 |
---|---|
Provider Name | Dr. Izzat H Shah |
First Address | Flemington, NJ 08822-4600 |
Second Address | Bridgewater, NJ 08807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 21/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0294799 | (05) | NJ |
G38234 | (02) | NJ |