Provider Demographics
NPI:1164495909
Name:SHINDE, TEJAS (MD)
Entity type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:
Last Name:SHINDE
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 1:1131 BROAD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4329
Mailing Address - Country:US
Mailing Address - Phone:732-578-9640
Mailing Address - Fax:732-578-9650
Practice Address - Street 1:1131 BROAD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4329
Practice Address - Country:US
Practice Address - Phone:732-578-9640
Practice Address - Fax:732-578-9650
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0431902085R0202X
NJ25MA081392002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0114081Medicaid
NJ0114081Medicaid
I21301Medicare UPIN