Provider Demographics
NPI:1790928521
Name:SHAKOV, EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:
Last Name:SHAKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 IRON BRIDGE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5304
Mailing Address - Country:US
Mailing Address - Phone:732-845-5001
Mailing Address - Fax:732-358-0524
Practice Address - Street 1:501 IRON BRIDGE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5304
Practice Address - Country:US
Practice Address - Phone:732-845-5001
Practice Address - Fax:732-358-0524
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08547700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ185625YXAZMedicare UPIN