Active NPI
Avni Shah, DMD
- General Practice Dentistry
- Iselin, NJ
National Provider Identifier
1013321843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22DI02560600
- Practice address
- 118 Fiume St
Iselin, NJ 08830-1407 - Phone
- (201) 725-0603
- NPI assigned
- Jun 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI02560600 | NJ | Primary |
Addresses
Primary practice location
118 Fiume St
Iselin, NJ 08830-1407
Mailing address
118 Fiume St
Iselin, NJ 08830-1407
Phone (201) 725-0603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160223000502 | NJ | Order and Referring Only - Dentist | 5496050858 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02560600 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403136000000",
"number": "1013321843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "118 FIUME ST",
"city": "ISELIN",
"state": "NJ",
"postal_code": "088301407",
"telephone_number": "201-725-0603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 FIUME ST",
"city": "ISELIN",
"state": "NJ",
"postal_code": "088301407",
"telephone_number": "201-725-0603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "AVNI",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-19",
"last_updated": "2014-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI02560600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iselin, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.