Individual
JACK M SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
20 MAGNOLIA AVE, SUITE C, BRIDGETON, NJ 08302-1759
(856) 455-8833
(856) 453-8358
Mailing address
20 MAGNOLIA AVE, SUITE C, BRIDGETON, NJ 08302-1759
(856) 455-8833
(856) 453-8358
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA35038
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3019501
—
NJ
Enumeration date
07/03/2006
Last updated
07/08/2007
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