Provider Demographics
NPI:1750327326
Name:SCHENKER, SAMUEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DAVID
Last Name:SCHENKER
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 1:388 LAKEHURST RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7340
Mailing Address - Country:US
Mailing Address - Phone:732-341-2822
Mailing Address - Fax:732-341-7087
Practice Address - Street 1:388 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7340
Practice Address - Country:US
Practice Address - Phone:732-341-2822
Practice Address - Fax:732-341-7087
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41188174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
433628Medicare ID - Type Unspecified
NJC54908Medicare UPIN