Provider Demographics
NPI:1619065059
Name:SHAIMAN, ALAN MARC (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:MARC
Last Name:SHAIMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 YANTACAW BROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2524
Mailing Address - Country:US
Mailing Address - Phone:201-942-3999
Mailing Address - Fax:201-942-3998
Practice Address - Street 1:631 GRAND ST
Practice Address - Street 2:JERSEY CITY RADIATION ONCOLOGY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3451
Practice Address - Country:US
Practice Address - Phone:201-942-3999
Practice Address - Fax:201-942-3998
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040122002085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1289403Medicaid
NJD06978Medicare UPIN
NJ575862Medicare ID - Type Unspecified