Provider Demographics
NPI:1184224107
Name:MARKOVITZ, SHOSHANA (PNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:MARKOVITZ
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:DREBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:176 TUDOR CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1471
Mailing Address - Country:US
Mailing Address - Phone:443-844-7144
Mailing Address - Fax:
Practice Address - Street 1:450 E KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1488
Practice Address - Country:US
Practice Address - Phone:443-844-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01070500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty