1306864962 NPI number — ROBERT SHANIK MD

Table of content: ROBERT SHANIK MD (NPI 1306864962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306864962 NPI number — ROBERT SHANIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHANIK
Provider First Name:
ROBERT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306864962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 BEY LEA RD
Provider Second Line Business Mailing Address:
STE B203
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-341-0720
Provider Business Mailing Address Fax Number:
732-244-6842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 BEY LEA RD
Provider Second Line Business Practice Location Address:
STE B203
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-341-0720
Provider Business Practice Location Address Fax Number:
732-244-6842
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  25MA03333200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00242 . This is a "QUALCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1017615 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51573 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: OK2986 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1017616 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11238 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 63A171 . This is a "WELCHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PL400032 . This is a "BCBS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0882208 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162928 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: VP002 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0058506000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000166201 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1017614 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1066877 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4372459 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16462 . This is a "UNIVERSITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2699918 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 558851 . This is a "WELCHOICE" identifier . This identifiers is of the category "OTHER".




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