Healthcare Provider Details

I. General information

NPI: 1932527058
Provider Name (Legal Business Name): SHAKIL A. SHAIKH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 KLOCKNER RD
HAMILTON NJ
08690-3414
US

IV. Provider business mailing address

2073 KLOCKNER RD
HAMILTON NJ
08690-3414
US

V. Phone/Fax

Practice location:
  • Phone: 609-584-1212
  • Fax: 609-584-0103
Mailing address:
  • Phone: 609-584-1212
  • Fax: 609-584-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MB11152500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MB11152500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: