Provider Demographics
NPI:1720007743
Name:SHAKARJIAN, CARNIG C (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARNIG
Middle Name:C
Last Name:SHAKARJIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 KINDERKAMACK RD
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630
Mailing Address - Country:US
Mailing Address - Phone:201-986-1633
Mailing Address - Fax:201-986-1655
Practice Address - Street 1:99 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630
Practice Address - Country:US
Practice Address - Phone:201-986-1633
Practice Address - Fax:201-986-1655
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00203300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4519108Medicaid
NJU20735Medicare UPIN
NJ686697Medicare PIN