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General NPI Number Information
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NPI Number | 1508132200
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Entity Type | Individual
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Provider Name | SHAMIK CHAKRABORTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 901 W MAIN ST STE 267
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 609-921-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 901 W MAIN ST STE 267
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City | FREEHOLD
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State | NJ
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Zip | 07728-2537
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Country | US
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Telephone | 609-921-9001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 25MA10680000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD470272
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License Number State | PA
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