Provider Demographics
NPI:1689183311
Name:MARTIN D. SCHLAKMAN, M.D. LLC
Entity Type:Organization
Organization Name:MARTIN D. SCHLAKMAN, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-549-2220
Mailing Address - Street 1:1109 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2877
Mailing Address - Country:US
Mailing Address - Phone:732-549-2220
Mailing Address - Fax:732-603-0673
Practice Address - Street 1:1109 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2877
Practice Address - Country:US
Practice Address - Phone:732-549-2220
Practice Address - Fax:732-603-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO65666002084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty