Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02314300 | NJ |
Y | 1223X0400X | Orthodontists | 22DI02314300 | NJ |
NPI | 1073703419 |
---|---|
Provider Name | Paresh Shah |
First Address | Old Bridge, NJ 08857-2795 |
Second Address | South Plainfield, NJ 07080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 13/04/2021 |