Provider Demographics
NPI:1861805426
Name:SHAH, ANKIT SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:ANKIT
Middle Name:SURESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANKIT
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:205 S ORANGE AVE STE A-1120
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2785
Mailing Address - Country:US
Mailing Address - Phone:973-972-5108
Mailing Address - Fax:
Practice Address - Street 1:205 S ORANGE AVE STE A-1120
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2785
Practice Address - Country:US
Practice Address - Phone:973-972-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT207380207R00000X
NJ25MA10833100207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty