Provider Demographics
NPI:1053538835
Name:SHAH, NUPUR V (PT)
Entity type:Individual
Prefix:MRS
First Name:NUPUR
Middle Name:V
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FARMHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3237
Mailing Address - Country:US
Mailing Address - Phone:848-248-0357
Mailing Address - Fax:
Practice Address - Street 1:15 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1823
Practice Address - Country:US
Practice Address - Phone:718-984-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028102-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare ID - Type Unspecified