Provider Demographics
NPI:1518055896
Name:SHAMMASH, JONATHAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:SHAMMASH
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 1:385 PROSPECT AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2570
Mailing Address - Country:US
Mailing Address - Phone:551-996-9150
Mailing Address - Fax:551-996-9144
Practice Address - Street 1:385 PROSPECT AVE STE 204
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2570
Practice Address - Country:US
Practice Address - Phone:551-996-9150
Practice Address - Fax:551-996-9144
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206910207R00000X
NJ25MA08593400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01771219Medicaid
NJ162876CYAMedicare PIN
NYG25308Medicare UPIN