Healthcare Provider Details

I. General information

NPI: 1760080196
Provider Name (Legal Business Name): SHAKER MEDICAL GROUP-HOSPITALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 10/16/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD STE 301
HACKENSACK NJ
07601-1749
US

IV. Provider business mailing address

155 POLIFLY RD STE 301
HACKENSACK NJ
07601-1749
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6360
  • Fax:
Mailing address:
  • Phone: 201-343-6360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. DAVID S SHAKER
Title or Position: OWNER
Credential: DO
Phone: 201-343-6360