Individual
DR. EDWARD CHARLES SHADIACK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1200 NE CENTRAL AVE # 02, SEASIDE PARK, NJ 08752-1306
(732) 830-4884
Mailing address
1200 NE CENTRAL AVE # 02, SEASIDE PARK, NJ 08752-1306
(732) 830-4884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB41240
NJ
Other
Enumeration date
09/21/2006
Last updated
07/08/2007
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