Individual provider Active NPI

Chandravadan I Shah, MD

  • Obstetrics & Gynecology Physician
  • Lakewood, NJ
National Provider Identifier
1881654168
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
25MA04906800 Issued in NJ
Practice address
101 2ND St
Ohi Inc
Lakewood, NJ 08701-3324
Phone
(732) 363-6655
Fax
(732) 363-6656
NPI assigned
Mar 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 25MA04906800 NJ Primary

Addresses

Primary practice location

101 2ND St
Ohi Inc
Lakewood, NJ 08701-3324

Mailing address

101 2ND St
Lakewood, NJ 08701-3324
Phone (732) 363-6655

Other identifiers 1

IdentifierTypeStateIssuer
1264303MedicaidNJ

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
I20060908000151 NJ Practitioner - Obstetrics/Gynecology 4789688516 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ocean Health Initiatives Inc Obstetrics & Gynecology Current Accepting new patients
Ocean Health Initiatives,Inc CurrentSince Jun 1, 2007 Accepting new patients
Ocean Health Initiatives, Inc CurrentSince Jun 1, 2007 Accepting new patients

Locations

101 2nd St
Lakewood, NJ 08701
Phone (732) 886-4809

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1881654168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 2ND ST",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013324",
            "telephone_number": "732-363-6655",
            "fax_number": "732-363-6656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 2ND ST",
            "address_2": "OHI INC",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013324",
            "telephone_number": "732-363-6655",
            "fax_number": "732-363-6656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "CHANDRAVADAN",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NJ",
            "license": "25MA04906800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1264303",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.