Shan Nagendra,M.D.P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA30013 Issued in NJ

Legal business name

SHAN NAGENDRA,M.D.P.C.

Practice address

654 Avenue C
Bayonne, NJ 07002-3899

Phone

(201) 823-3390

Fax

(201) 823-4420

NPI assigned

Dec 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shan Nagendra, M.D.NPI 1164533659

Title

Owner

Phone

(201) 823-3390

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shan M Nagendra, M.D.

  • Psychiatry Physician
  • Clifton, NJ
  • NPI 1164533659

  Specialist

  Medicare reassignment NPD Authorized official
• John Bortolussi, D.C.

  • Chiropractor
  • Clifton, NJ
  • NPI 1730289729
  NPD (past)
• Emad Malak Gabriel, DPM

  • Foot Surgery Podiatrist
  • Bayonne, NJ
  • NPI 1750686580
  NPD (past)
• Emmanuel Hriso, MD

  • Psychiatry Physician
  • Woodbridge, NJ
  • NPI 1942217328
  NPD (past)
• Paul A Hriso, MD PA

  • Psychiatry Physician
  • Bayonne, NJ
  • NPI 1295754158
  NPD (past)
• Jacob H Jacoby, MD PHD

  • Psychiatry Physician
  • Bayonne, NJ
  • NPI 1174648232
  NPD (past)
• Fawad A Mian, MD

  • Neurology Physician
  • Denville, NJ
  • NPI 1306006242
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1174705776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "654 AVENUE C",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023899",
            "telephone_number": "201-823-3390",
            "fax_number": "201-823-4420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "654 AVENUE C",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "070023899",
            "telephone_number": "201-823-3390",
            "fax_number": "201-823-4420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAN NAGENDRA,M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "NAGENDRA",
        "authorized_official_first_name": "SHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-823-3390",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "MA30013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3195503",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Priscilla Seshie
• Emanoil Shafik, DPM
• Selvia Shafik
• Rehan Shah, M.D.
• Sonal V Shah, MS, RD, CNSC
• Nedaa Sharobeem, MD
• Caitlin Noel Sharp, M.A., CCC-SLP
• Andrew Shehata, DO
• Sandy Shehata, MA, LAC
• Muhammad Bilal Sheikh, PHARMD

• Specialist in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.