1497729842 NPI number — TATYANA SHKOLNAYA M.D.

Table of content: TATYANA SHKOLNAYA M.D. (NPI 1497729842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497729842 NPI number — TATYANA SHKOLNAYA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHKOLNAYA
Provider First Name:
TATYANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1497729842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1540 HWY 138
Provider Second Line Business Mailing Address:
BLDG. 1, SUITE 105
Provider Business Mailing Address City Name:
WALL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07719-3763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-280-3100
Provider Business Mailing Address Fax Number:
732-280-3103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 HIGHWAY 138
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WALL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07719-3763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-280-3100
Provider Business Practice Location Address Fax Number:
732-280-3103
Provider Enumeration Date:
02/14/2006

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:  25MA06638500 , 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: 2195492 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2418547001 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2576793 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1134545429 . This is a "NPI/CANDLEWOOD PEDIATRICS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 364531830 . This is a "1199 MEMBERS CHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 58524 . This is a "825 HEALTH PLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7028795003 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2863719 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 364531830 . This is a "HEALTHCARE PAYORS CO." identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 364531830 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8394903 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2200027 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 364531830 . This is a "EMPIRE BLUE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 364531830 . This is a "ST. BARNABAS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2695578 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OC-000003507 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 364531830 . This is a "ALL HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 364531830 . This is a "PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1157405 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2K9182 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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