Provider Demographics
NPI:1447577028
Name:SHAH, MEHUL D (DO)
Entity type:Individual
Prefix:DR
First Name:MEHUL
Middle Name:D
Last Name:SHAH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 BROAD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3066
Mailing Address - Country:US
Mailing Address - Phone:877-532-7837
Mailing Address - Fax:
Practice Address - Street 1:210 MOUNTS CORNER DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2547
Practice Address - Country:US
Practice Address - Phone:877-543-7823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09690700208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0467260Medicaid
NJ427934Medicare UPIN