MEDICARE: SHATKIN CARDIOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA52095	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0100030120	OTHER	NJ	AMERICHOICE
2	2264673	OTHER	NH	CIGNA
3	P379352	OTHER	NJ	OXFORD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4090043	OTHER	NJ	AETNA
6	2285745000	OTHER	NJ	AMERIHEALTH
7	60008152	OTHER	NJ	HORIZON NJ HEALTH

General Provider Information

NPI Number	:	1457575540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHATKIN CARDIOLOGY, LLC

Provider Business Mailing Address
First Line	:	6083 WILDCAT RUN
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33412-3006
Country	:	US
Telephone Number	:	609-774-5372
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 SEAPOINTE BLVD
Second Line	:
City	:	WILDWOOD CREST
State	:	NJ
Zip	:	08260-6203
Country	:	US
Telephone Number	:	609-774-5372
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. BENNETT SHATKIN
Credential	:	MD
Telephone Number	:	609-774-5372

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	03/22/2016

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