| Shukla Medical Group, Llc | |
|
1 W. Ridgewood Avenue Suite 203 Paramus NJ 07652 | |
| (201) 652-8800 | |
| (201) 444-8560 |
| Full Name | Shukla Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1 W. Ridgewood Avenue, Paramus, New Jersey |
| Authorized Official Name and Position | Nilesh B Shukla (OWNER) |
| Authorized Official Contact | 2012867400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shukla Medical Group, Llc P.o. Box 932 Glen Rock NJ 07452 Ph: (201) 652-8800 | Shukla Medical Group, Llc 1 W. Ridgewood Avenue Suite 203 Paramus NJ 07652 Ph: (201) 652-8800 |
| NPI Number | 1184753865 |
|---|---|
| Provider Enumeration Date | 03/05/2007 |
| Last Update Date | 03/21/2014 |
| Medicare PECOS PAC ID | 3274638200 |
|---|---|
| Medicare Enrollment ID | O20070419000170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184753865 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 25MA07868700 (New Jersey) | Primary |
| Provider Name | Nilesh B Shukla |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1710058334 PECOS PAC ID: 5294779831 Enrollment ID: I20050615000257 |
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