Provider Demographics
NPI:1841784360
Name:SPECIALTY PHYSICIANS NJ
Entity Type:Organization
Organization Name:SPECIALTY PHYSICIANS NJ
Other - Org Name:SPECIALTY PHYSICIANS NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-845-5001
Mailing Address - Street 1:501 IRON BRIDGE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5305
Mailing Address - Country:US
Mailing Address - Phone:732-845-5001
Mailing Address - Fax:732-358-0524
Practice Address - Street 1:501 IRON BRIDGE RD STE 9
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5305
Practice Address - Country:US
Practice Address - Phone:732-845-5001
Practice Address - Fax:732-358-0524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-18
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty