Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1013382548 |
---|---|
Provider Name | Pradip Shah |
First Address | Dayton, NJ 08810-2436 |
Second Address | Dayton, NJ 08810-2436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2015 |
Last Update Date | 09/12/2015 |