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General NPI Number Information
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NPI Number | 1841784360
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Entity Type | Organization
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Legal Business Name | SPECIALTY PHYSICIANS NJ
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 501 IRON BRIDGE RD STE 9
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City | FREEHOLD
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State | NJ
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Zip | 07728-5305
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Country | US
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Telephone | 732-845-5001
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Fax | 732-358-0524
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Provider Business Mailing Address
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Address Line | 501 IRON BRIDGE RD STE 9
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City | FREEHOLD
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State | NJ
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Zip | 07728-5305
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Country | US
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Telephone | 732-845-5001
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Fax | 732-358-0524
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMIL SHAKOV
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Credential | MD
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Telephone | 732-845-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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