Provider Demographics
NPI:1497729842
Name:SHKOLNAYA, TATYANA (MD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:SHKOLNAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 HWY 138
Mailing Address - Street 2:BLDG. 1, SUITE 105
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3763
Mailing Address - Country:US
Mailing Address - Phone:732-280-3100
Mailing Address - Fax:732-280-3103
Practice Address - Street 1:1540 HIGHWAY 138
Practice Address - Street 2:SUITE 105
Practice Address - City:WALL
Practice Address - State:NJ
Practice Address - Zip Code:07719-3763
Practice Address - Country:US
Practice Address - Phone:732-280-3100
Practice Address - Fax:732-280-3103
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06638500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2195492OtherUNITED HEALTHCARE
NJ2418547001OtherAMERIHEALTH
NJP2576793OtherOXFORD
NJ1134545429OtherNPI/CANDLEWOOD PEDIATRICS
NJ364531830Other1199 MEMBERS CHOICE
NJ58524Other825 HEALTH PLAN
NJ7028795003OtherCIGNA
NJ2863719OtherAETNA
NJ364531830OtherHEALTHCARE PAYORS CO.
NJ364531830OtherQUALCARE
NJ8394903Medicaid
NJ2200027OtherFIRST HEALTH
NJ364531830OtherEMPIRE BLUE
NJ364531830OtherST. BARNABAS
NJ2695578OtherGHI
NJOC-000003507Medicaid
NJ364531830OtherALL HORIZON BCBS
NJ364531830OtherPHCS
NJ1157405Medicaid
NJ2K9182Medicaid
NJ42777Medicaid