Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MA43420 | NJ |
NPI | 1053451492 |
---|---|
Provider Name | Mahesh Maneklal Shah |
First Address | Cranford, NJ 07016-2158 |
Second Address | Cranford, NJ 07016-2158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54367 | (02) | NJ |