Organization
SHREE TARA DIVERSIFIED
Active
Other names
DeRosa Medical Supplies
Organization subpart
No
Provider details
NPI number
Authorized official
KUSHYUP SHAH MD (OWNER)
(201) 766-5538
Entity
Organization
Contact information
Practice address
2115 BERGENLINE AVE, UNION CITY, NJ 07087-3507
(201) 766-5538
(201) 319-9340
Mailing address
2115 BERGENLINE AVE, UNION CITY, NJ 07087-3507
(201) 766-5538
(201) 319-9340
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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