Provider Demographics
NPI:1306864962
Name:SHANIK, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SHANIK
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 1:40 BEY LEA RD
Mailing Address - Street 2:STE B203
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-341-0720
Mailing Address - Fax:732-244-6842
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:STE B203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-341-0720
Practice Address - Fax:732-244-6842
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03333200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00242OtherQUALCARE
1017615OtherHORIZON NJ HEALTH
51573OtherCIGNA HMO
OK2986OtherHEALTHNET
1017616OtherHORIZON NJ HEALTH
11238OtherAETNA HMO
63A171OtherWELCHOICE
PL400032OtherBCBS PPO
NJ0882208Medicaid
162928OtherAMERIHEALTH PPO
VP002OtherOXFORD
0058506000OtherAMERIHEALTH HMO
01000166201OtherAMERICHOICE
1017614OtherHORIZON NJ HEALTH
1066877OtherCAQH
4372459OtherAETNA PPO
16462OtherUNIVERSITY
2699918OtherGHI
558851OtherWELCHOICE