Provider Demographics
NPI:1033164553
Name:SHOENFELD, RICHARD B (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:SHOENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ROUTE 66
Mailing Address - Street 2:SUITE 131
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7300
Mailing Address - Country:US
Mailing Address - Phone:732-383-4173
Mailing Address - Fax:732-741-1895
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-243-9729
Practice Address - Fax:973-243-9674
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040582002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ711608Medicaid
NJ622764CQHMedicare PIN
NJ622764A2VMedicare PIN
E52531Medicare UPIN
NJ300022515Medicare PIN
NJ300017324Medicare PIN