Provider Demographics
NPI:1730328394
Name:SHAH, ASHISH C (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3086 STATE ROUTE 27
Mailing Address - Street 2:SUITE 10
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1658
Mailing Address - Country:US
Mailing Address - Phone:844-543-5864
Mailing Address - Fax:844-314-1144
Practice Address - Street 1:3086 STATE ROUTE 27
Practice Address - Street 2:SUITE 10
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1658
Practice Address - Country:US
Practice Address - Phone:844-543-5864
Practice Address - Fax:844-314-1144
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2016-12-13
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Provider Licenses
StateLicense IDTaxonomies
NC2008-019312080P0214X
NJ25MA097748002080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0525278Medicaid
SCQ01931Medicaid
NC1730328394Medicaid