Most Relevant Information
Provider Data
| NPI Number: | 1003304940 |
| Provider Name: | ROSHAN SURESHCHANDRA SHAH MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/26/2018 |
| Last Updated: | 08/10/2021 |
Provider Practice Location
30 PROSPECT AVE
HACKENSACK
NJ
076011915
Practice Location Phone/Fax
| Phone: | 5519963500 |
| Fax: |
Provider Mailing Location
3600 ROUTE 66
FL 3
NEPTUNE
NJ
077532645
Provider Mailing Phone/Fax
| Phone: | 7328070879 |
| Fax: | 2017511680 |