Provider Demographics
NPI:1053335646
Name:SHORE KIDNEY AND HYPERTENSION SPECIALISTS LLC
Entity type:Organization
Organization Name:SHORE KIDNEY AND HYPERTENSION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHETAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-788-8265
Mailing Address - Street 1:13 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-4221
Mailing Address - Country:US
Mailing Address - Phone:609-788-8265
Mailing Address - Fax:609-465-2201
Practice Address - Street 1:13 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-4221
Practice Address - Country:US
Practice Address - Phone:609-788-8265
Practice Address - Fax:609-465-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06618100207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8490104Medicaid
H21952Medicare UPIN
NJ8490104Medicaid