Provider Demographics
NPI:1053736520
Name:SHAH, ANUJ (PT, MA)
Entity type:Individual
Prefix:
First Name:ANUJ
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MARIN BLVD
Mailing Address - Street 2:APT 8A
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3654
Mailing Address - Country:US
Mailing Address - Phone:917-768-3181
Mailing Address - Fax:
Practice Address - Street 1:1110 2ND AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2021
Practice Address - Country:US
Practice Address - Phone:212-842-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037030-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist