Individual
DR. EVAN T. SHACK
Active
Individual
DR. EVAN T. SHACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25MA07398800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163572
HORIZON NJ HEALTH
—
01
—
2117877000
AMERIHEALTH
—
01
—
2201310
UNITED HEALTHCARE
—
01
—
2978264
AETNA
—
01
—
300131187
RAILROAD MEDICARE
—
05
—
8839301
—
NJ
01
—
A3738029
OXFORD HEALTH
—
01
—
SH1433148
HIGHMARK PA BLUE SHIELD
—
Enumeration date
09/02/2005
Last updated
09/27/2012
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