Individual
DR. LYDIA SHAJENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
725 RIVER RD STE 55, EDGEWATER, NJ 07020-1121
(646) 712-1635
(866) 267-8173
Mailing address
725 RIVER RD STE 55, EDGEWATER, NJ 07020-1121
(646) 712-1635
(866) 267-8173
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
216559
NY
2084N0600X
Clinical Neurophysiology Physician
Primary
25MA08061700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01484083
—
NJ
Enumeration date
10/14/2005
Last updated
10/26/2017
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