Provider Demographics
NPI:1144216342
Name:SCHACKMAN, PAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:SCHACKMAN
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 1:1317 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3309
Mailing Address - Country:US
Mailing Address - Phone:908-964-9370
Mailing Address - Fax:908-964-9308
Practice Address - Street 1:1317 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3309
Practice Address - Country:US
Practice Address - Phone:908-964-9370
Practice Address - Fax:908-964-9308
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04208700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3283801Medicaid
NJB19212Medicare UPIN
NJ3283801Medicaid