Healthcare Provider Details

I. General information

NPI: 1083308266
Provider Name (Legal Business Name): EMANOIL SHAFIK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SOUTHWOOD DR
OLD BRIDGE NJ
08857-1461
US

IV. Provider business mailing address

55 SOUTHWOOD DR
OLD BRIDGE NJ
08857-1461
US

V. Phone/Fax

Practice location:
  • Phone: 347-576-4417
  • Fax:
Mailing address:
  • Phone: 347-576-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00391100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN007500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: