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NPI Code Detail

MEDICARE: DR. BERNARD PELLMAN SHAGAN M.D.

MEDICARE: DR. BERNARD PELLMAN SHAGAN M.D.
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
1207RE0101XEndocrinology, Diabetes & Metabolism PhysicianMA49925NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912925769
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BERNARD PELLMAN SHAGAN M.D.
Provider Business Mailing Address
First Line : 255 3RD AVE
Second Line :
City : LONG BRANCH
State : NJ
Zip : 07740-6214
Country : US
Telephone Number : 732-222-5200
Fax Number : 732-741-3082
Provider Business Practice Location Address
First Line : 300 2ND AVE
Second Line : DEPARTMENT OF MEDICINE
City : LONG BRANCH
State : NJ
Zip : 07740-6303
Country : US
Telephone Number : 732-222-5200
Fax Number : 732-741-3082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 06/21/2026

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