Provider Demographics
NPI:1861608085
Name:NAYANESH K. SHAH, D.D.S., LLC
Entity type:Organization
Organization Name:NAYANESH K. SHAH, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYANESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-299-6161
Mailing Address - Street 1:1081 PARSIPPANY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1291
Mailing Address - Country:US
Mailing Address - Phone:973-299-6161
Mailing Address - Fax:973-299-1800
Practice Address - Street 1:1081 PARSIPPANY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1291
Practice Address - Country:US
Practice Address - Phone:973-299-6161
Practice Address - Fax:973-299-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ162721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1305506Medicaid