Provider Demographics
NPI:1477618510
Name:SHENKMAN, JEROME STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:STANLEY
Last Name:SHENKMAN
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 1:11 COLES CT
Mailing Address - Street 2:
Mailing Address - City:RIVER EDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07661-1001
Mailing Address - Country:US
Mailing Address - Phone:201-489-5744
Mailing Address - Fax:201-945-4288
Practice Address - Street 1:103 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1016
Practice Address - Country:US
Practice Address - Phone:201-945-4288
Practice Address - Fax:201-945-8690
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03121000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA03121000OtherMEDICAL LICENSE #
NJD01924100OtherCDS#
NJD01924100OtherCDS#
NJC56162Medicare UPIN