DR. PRATIK A SHUKLA (NPI# 1457614141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457614141 |
| Entity Type | Individual |
| Full Name | DR. PRATIK A SHUKLA |
| Credential | M.D. |
| Practice Address |
150 Bergen St # Streetc Newark NJ 07103 |
| Mailing Address |
30 Bergen Street Building 12 Room 1205 Newark NJ 07107-3000 |
| Practice Telephone | 9739725188 |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-03-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | MT202262 | PA | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
25MA10336900 | NJ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | 0640930 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 801 Ostrum St, Bethlehem, PA 180151000 | 4845264000 | |
| 30 Bergen St # 121205, Newark, NJ 07107 | 9739720037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417902768 | Pratik Rohit Shukla | Radiology | 425 Brighton St, #303, Bethlehem, PA 18015-1273 | 2006-05-24 |
| Street Address |
150 BERGEN ST # STREETC |
| City | NEWARK |
| State | NJ |
| Zip Code | 07103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912990680 | Maureen Gang | Emergency Medicine | 150 Bergen St # Streetc, Newark, NJ 07103 | 2005-08-26 |
| 1780903278 | Basit Khan Achakzai | Radiology | 150 Bergen St # Streetc, Newark, NJ 07103 | 2010-05-24 |
| 1881644359 | Mahmoud Dakhel | Nuclear Medicine | 150 Bergen St # Streetc, Newark, NJ 07103 | 2006-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124657077 | Yingna Liu | Student in an Organized Health Care Education/Training Program | Medical Science Building, 185 South Orange Avenue, Newark, NJ 07103 | 2020-04-03 |
| 1568029684 | Martins Akhibi | Nurse Practitioner | 178 Newton Street, Newark, NJ 07103 | 2019-05-23 |
| 1972168482 | Newark Renaissance House, Inc | Rehabilitation, Substance Use Disorder Unit | 50-56 Norfolk Street, Newark, NJ 07103 | 2019-05-09 |
| 1346709235 | Ian Wang Yu | Student in an Organized Health Care Education/Training Program | 185 South Orange Ave., Medical Science Building, Room I-506, Newark, NJ 07103 | 2019-03-19 |
| 1437648417 | Stephen Vanbeek | Internal Medicine | 185 S Orange Ave Rm 547, Newark, NJ 07103 | 2018-05-06 |
| 1073019444 | Geoffrey Alexander Talis | Student in an Organized Health Care Education/Training Program | 183 S. Orange Avenue, Level E, Room 1452, Newark, NJ 07103 | 2018-04-03 |
| 1285139907 | Thomas Georg Bachmann | Student in an Organized Health Care Education/Training Program | 185 South Orange Ave, Medical Science Building, G-538, Newark, NJ 07103 | 2018-03-26 |
| 1154825289 | Shammi A Patel | Student in an Organized Health Care Education/Training Program | 185 S Orange Ave # Msbg594, Newark, NJ 07103 | 2018-03-22 |
| 1982122545 | North Jersey Aids Alliance | Clinic/Center | 393 Central Avenue C/o Corey Destefano, Newark, NJ 07103 | 2017-09-05 |
| 1134655533 | Yasmin N Abedin | Student in an Organized Health Care Education/Training Program | 185 South Orange Ave, Msb E-506, Rutgers, New Jersey Medical School, Newark, NJ 07103 | 2017-05-04 |
| Find all providers in zip 07103 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740706175 | Delaware Radiology Associates Pa | Radiology | 6 Omega Dr Bldg L, Newark, DE 19713-2056 | 2017-08-17 |
| 1912133109 | Oluwole Ayodeji Tairu | Radiology | 150 Bergen St Level C, Newark, NJ 07103-2496 | 2009-06-02 |
| 1548435290 | Denis Primakov | Radiology | 4755 Ogletown Stanton Rd Ste 1752, Newark, DE 19718-2200 | 2008-04-24 |
| 1518163773 | Samson Wong | Radiology | 4755 Ogletown Stanton Rd Rm 1752, Newark, DE 19718-6402 | 2007-06-25 |
| 1386864635 | Open Mri & Imaging of Newark | Radiology | 243 Chestnut Street, Newark, NJ 07105-6501 | 2007-04-27 |
| 1194853952 | Anton Grant Delport | Radiology | 4755 Ogletown-stanton, Roadroom 2a00-christiana Hospital, Newark, DE 19718-0001 | 2007-03-01 |
| 1316028665 | Edward A Del Grosso | Radiology | 1320 W. Main Street, Newark, OH 43055-1822 | 2006-10-17 |
| 1720172885 | Delaware Womens Imaging LLC | Radiology | J-24 Omega Drive, Newark, DE 19713 | 2006-10-03 |
| 1659484467 | An Open Mri Imaging of Newark, LLC | Radiology | 243 Chestnut St., Newark, NJ 07105-6501 | 2006-08-16 |
| 1083645394 | Helen Sax | Radiology | J24 Omega Drive, Newark, DE 19713-2060 | 2006-07-05 |
| Find all providers in NEWARK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.