Provider Demographics
NPI:1184765513
Name:SHAH, NALINI (MD)
Entity type:Individual
Prefix:
First Name:NALINI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07513-1612
Mailing Address - Country:US
Mailing Address - Phone:973-345-2142
Mailing Address - Fax:973-345-1626
Practice Address - Street 1:415 21ST AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07513-1612
Practice Address - Country:US
Practice Address - Phone:973-345-2142
Practice Address - Fax:973-345-1626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2113601Medicaid
NJE51246Medicare UPIN
NJ071258Medicare ID - Type UnspecifiedGROUP ID
NJ2113601Medicaid