Provider Demographics
NPI:1902084791
Name:SHAH, BINDI (DO)
Entity Type:Individual
Prefix:DR
First Name:BINDI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTCLAIR STATE UNIVERSITY
Mailing Address - Street 2:1 NORMAL AVE
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1624
Mailing Address - Country:US
Mailing Address - Phone:973-655-5211
Mailing Address - Fax:973-655-4470
Practice Address - Street 1:MONTCLAIR STATE UNIVERSITY; CAPS
Practice Address - Street 2:1 NORMAL AVE
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1624
Practice Address - Country:US
Practice Address - Phone:973-655-5211
Practice Address - Fax:973-655-4470
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB072114002084P0800X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry