Provider Demographics
NPI:1457575540
Name:SHATKIN CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:SHATKIN CARDIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-774-5372
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0100030120OtherAMERICHOICE
NH2264673OtherCIGNA
NJP379352OtherOXFORD
NJ0528307Medicaid
NJ4090043OtherAETNA
NJ2285745000OtherAMERIHEALTH
NJ60008152OtherHORIZON NJ HEALTH
NH2264673OtherCIGNA
NJ60008152OtherHORIZON NJ HEALTH
NJ2285745000OtherAMERIHEALTH