Provider Demographics
NPI:1174113120
Name:SHETH, AMIT
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:SHETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NUTMEG RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1361
Mailing Address - Country:US
Mailing Address - Phone:732-207-3527
Mailing Address - Fax:
Practice Address - Street 1:186 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-7006
Practice Address - Country:US
Practice Address - Phone:732-222-1481
Practice Address - Fax:732-870-0603
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02632300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02632300OtherSTATE PHARMACY LICENSE