Provider Demographics
NPI:1548487358
Name:SHAH, IRAM FATIMA (PT)
Entity type:Individual
Prefix:MRS
First Name:IRAM
Middle Name:FATIMA
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:IRAM
Other - Middle Name:FATIMA
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2 ELLIOT DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-2905
Mailing Address - Country:US
Mailing Address - Phone:732-634-6904
Mailing Address - Fax:
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3654
Practice Address - Country:US
Practice Address - Phone:732-324-5042
Practice Address - Fax:732-324-3121
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01073500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist