Provider Demographics
NPI:1669529202
Name:SHATKIN, JASON A (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:SHATKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:A
Other - Last Name:SHATKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 SEARS DR STE 306
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3510
Mailing Address - Country:US
Mailing Address - Phone:201-830-2287
Mailing Address - Fax:201-830-2286
Practice Address - Street 1:1 SEARS DR STE 306
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3510
Practice Address - Country:US
Practice Address - Phone:201-830-2287
Practice Address - Fax:201-830-2286
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07216300207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
046737AD7QOtherMEDICARE PTAN
NJ1K6952OtherHEALTHNET PROVIDER ID
NJ8574707Medicaid
NJ046737CGNMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID
NJP2480743OtherOXFORD PROVIDER ID