Provider Demographics
NPI:1144215963
Name:SHAH, PRANAV N (MD)
Entity type:Individual
Prefix:
First Name:PRANAV
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 RIVERVIEW PLZ
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1863
Mailing Address - Country:US
Mailing Address - Phone:732-747-1429
Mailing Address - Fax:732-747-4778
Practice Address - Street 1:6 RIVERVIEW PLZ
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1863
Practice Address - Country:US
Practice Address - Phone:732-747-1429
Practice Address - Fax:732-747-4778
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA596102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2011112OtherUNITED HEALTHCARE
NJ651U51OtherWELLCHOICE
NJ3629272OtherAETNA HMO
NJ913160OtherUSA MANAGED CARE
NJ2121288000OtherAMERIHEALTH
NJ3000957OtherAETNA HMO
NJ4099586OtherGHI
NJP00053557OtherRR MEDICARE
NJ1165209OtherHORIZON/MERCY
NJ0007710377OtherAETNA POS
NJ8642800Medicaid
NJ9012122-006OtherCIGNA
NJ94356OtherAMERIGROUP
NJ4099586OtherGHI
NJ651U51OtherWELLCHOICE