Individual
DR. DEEPAK O SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
142 PALISADE AVE STE 103, JERSEY CITY, NJ 07306-1108
(201) 792-2727
(201) 653-3420
Mailing address
PO BOX 947, CLARK, NJ 07066-0947
(201) 792-2727
(201) 653-3420
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MA36851
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0578703
—
NJ
01
—
178125
PTAN
NJ
Enumeration date
12/07/2006
Last updated
11/20/2018
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