Provider Demographics
NPI:1366674889
Name:SHUKLA, ASHISH (MD, MPH, FACC)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:SHUKLA
Suffix:
Gender:M
Credentials:MD, MPH, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-866-0800
Mailing Address - Fax:732-463-6082
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-866-0800
Practice Address - Fax:732-463-6082
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09691700207RC0000X, 204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ428766Medicare PIN