Active NPI
Samir Shah
- Pharmacist
- Jersey City, NJ
National Provider Identifier
1760869747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28RI03691300
- Practice address
- 2675 Kennedy Blvd
Apt K
Jersey City, NJ 07306-5847 - Phone
- (201) 682-6204
- NPI assigned
- Apr 29, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI03691300 | NJ | Primary |
Addresses
Primary practice location
2675 Kennedy Blvd
Apt K
Jersey City, NJ 07306-5847
Mailing address
638 Bayway Avenue
Goethals Pharmacy
Elizabeth, NJ 07202
Phone (908) 527-1112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03691300 | NJ | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430265600000",
"number": "1760869747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "638 BAYWAY AVENUE",
"address_2": "GOETHALS PHARMACY",
"city": "ELIZABETH",
"state": "NJ",
"postal_code": "07202",
"telephone_number": "908-527-1112",
"fax_number": "908-527-1155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2675 KENNEDY BLVD",
"address_2": "APT K",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073065847",
"telephone_number": "201-682-6204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "SAMIR",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-29",
"last_updated": "2015-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NJ",
"license": "28RI03691300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey City, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.