Provider Demographics
NPI:1336146695
Name:SHATKIN, BENNETT J (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:J
Last Name:SHATKIN
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 1:6083 WILDCAT RUN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-3006
Mailing Address - Country:US
Mailing Address - Phone:609-774-5372
Mailing Address - Fax:
Practice Address - Street 1:9901 SEAPOINTE BLVD
Practice Address - Street 2:#604
Practice Address - City:WILDWOOD CREST
Practice Address - State:NJ
Practice Address - Zip Code:08260-6203
Practice Address - Country:US
Practice Address - Phone:609-774-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ203BC0100Y207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0528307Medicaid
NJ468511Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJ0528307Medicaid