Provider Demographics
NPI:1073969325
Name:SHKOLNIK, EVGENY (MD)
Entity Type:Individual
Prefix:
First Name:EVGENY
Middle Name:
Last Name:SHKOLNIK
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 1:267 GRANT STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2805
Mailing Address - Country:US
Mailing Address - Phone:203-384-4677
Mailing Address - Fax:203-384-3135
Practice Address - Street 1:267 GRANT STREET
Practice Address - Street 2:BRIDGEPORT HOSPITAL INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610
Practice Address - Country:US
Practice Address - Phone:203-384-3792
Practice Address - Fax:203-384-4294
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-04-28
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2017-03-02
Provider Licenses
StateLicense IDTaxonomies
CT64281208M00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program