Provider Demographics
NPI:1831157270
Name:SHAH, DHARAMSI D (MD)
Entity type:Individual
Prefix:DR
First Name:DHARAMSI
Middle Name:D
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 1:11 MOUNTAIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3408
Mailing Address - Country:US
Mailing Address - Phone:973-204-5050
Mailing Address - Fax:
Practice Address - Street 1:11 MOUNTAIN RIDGE DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3408
Practice Address - Country:US
Practice Address - Phone:973-204-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0337320002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4946103Medicaid
NJ172272Medicare ID - Type Unspecified
NJD99057Medicare UPIN