Individual
MR. RICKY J SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1771 MADISON AVE, LAKEWOOD, NJ 08701-1242
(732) 364-2222
Mailing address
1771 MADISON AVE, LAKEWOOD, NJ 08701-1242
(245) 323-3872
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00586200
NJ
Other
Enumeration date
11/18/2013
Last updated
11/07/2024
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