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Individual

DR. PRATIK A SHUKLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
150 BERGEN ST # STREETC, NEWARK, NJ 07103
(973) 972-5188
Mailing address
30 BERGEN STREET, BUILDING 12 ROOM 1205, NEWARK, NJ 07107-3000

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT202262
PA
2085R0202X
Diagnostic Radiology Physician
Primary
25MA10336900
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0640930
NJ
Enumeration date
06/19/2012
Last updated
03/27/2019
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