Individual provider Active NPI

Dharamsi D Shah, M.D.

  • Psychiatry Physician
  • Livingston, NJ
National Provider Identifier
1831157270
Registry record updated Jan 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
25MA033732000 Issued in NJ
Practice address
11 Mountain Ridge Dr
Livingston, NJ 07039-3408
Phone
(973) 204-5050
NPI assigned
May 3, 2006
Last updated
Jan 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 25MA033732000 NJ Primary

Addresses

Primary practice location

11 Mountain Ridge Dr
Livingston, NJ 07039-3408

Mailing address

11 Mountain Ridge Dr
Livingston, NJ 07039-3408
Phone (973) 204-5050

Other identifiers 1

IdentifierTypeStateIssuer
4946103MedicaidNJ

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050505000694 NJ Practitioner - Psychiatry 8022058395 Reassigns benefits to 2 organizations
Practice locations: Livingston, NJ

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Oaks Hospital IncGroup PAC ID 8628047685, 12 clinicians

Practice addresses (Care Compare)

19 Prospect St
Summit, NJ 07901-2530
Phone (908) 522-7000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA033732000NJMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eoh Acquisition Group, LLC CurrentSince Jan 1, 2022 Accepting new patients
Summit Oaks Hospital Inc CurrentSince Sep 14, 2024 Accepting new patients
Essex Health Center PA PastSince Jan 1, 1990 Accepting new patients

Locations

240 Central Ave
East Orange, NJ 07018
Phone (973) 414-3473

240 Central Ave
Ste 100
East Orange, NJ 07018
Phone (973) 266-8416

300 Central Ave
East Orange, NJ 07018
Phone (973) 266-8460

310 Central Ave
Ste 105
East Orange, NJ 07018
Phone (862) 658-7190

19 Prospect St
Summit, NJ 07901
Phone (908) 522-7000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1831157270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MOUNTAIN RIDGE DR",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070393408",
            "telephone_number": "973-204-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MOUNTAIN RIDGE DR",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070393408",
            "telephone_number": "973-204-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "DHARAMSI",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA033732000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4946103",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.