NPIMap

Individual provider Active NPI

Mina Shaker, MD

  • Internal Medicine Physician
  • Hackensack, NJ
National Provider Identifier
1770977852
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA10249900 Issued in NJ
Practice address
38 Summit Ave
Hackensack, NJ 07601
Phone
(201) 343-6360
NPI assigned
Mar 26, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 25MA10249900 NJ Primary

Addresses

Primary practice location

38 Summit Ave
Hackensack, NJ 07601

Mailing address

155 Polifly Rd
Ste 301
Hackensack, NJ 07601-1749
Phone (201) 343-6360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180523002084 NJ Practitioner - Internal Medicine 0547525412 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Excelcare Medical Associates PAGroup PAC ID 4284647868, 200 clinicians

Practice addresses (Care Compare)

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone (201) 227-6050

Hospital & facility affiliations

  • Amedisys Home Health Home health agency, Hackensack, NJ, CCN 317047
  • Holy Name Home Care Home health agency, Teaneck, NJ, CCN 317077
  • Atlantic Visiting Nurse Home health agency, Morristown, NJ, CCN 317054
  • Holy Name Medical Center Hospital, Teaneck, NJ, CCN 310008
  • Hackensack Meridian Mountainside Medical Hospital, Montclair, NJ, CCN 310054
  • Valley Hospital Hospital, Paramus, NJ, CCN 310012
  • Hackensack University Medical Center Hospital, Hackensack, NJ, CCN 310001
  • Dellridge Health & Rehabilitation Center Nursing home, Paramus, NJ, CCN 315129
  • Family of Caring at Teaneck LLC Nursing home, Teaneck, NJ, CCN 315037
  • Emerson Health Care Center Nursing home, Emerson, NJ, CCN 315360
  • Careone at Wellington Nursing home, Hackensack, NJ, CCN 315152
  • Alaris Health at The Chateau Nursing home, Rochelle Park, NJ, CCN 315494

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Excelcare Medical Associates, PA Internal Medicine CurrentSince Nov 1, 2021 Accepting new patients
Holy Name Medical Center Inc. Past Accepting new patients
Montclair Hospital LLC Past Accepting new patients

Locations

341 Broad St
Clifton, NJ 07013
Phone (973) 461-3358

341 Broad St
Ste A
Clifton, NJ 07013

3 University Plz
Ste 205
Hackensack, NJ 07601

155 Polifly Rd
Ste 301
Hackensack, NJ 07601
Phone (201) 343-6360

155 Polifly Rd
Fl 3
Hackensack, NJ 07601

1 W Ridgewood Ave
Ste 203
Paramus, NJ 07652
Phone (201) 312-5243

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

147 Cedar Ln
Teaneck, NJ 07666
Phone (201) 287-1010

Interoperability endpoints

  • Direct secure messaging: mina.shaker@smg-nj.direct.office.nextgen.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1770977852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 POLIFLY RD",
            "address_2": "STE 301",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076011749",
            "telephone_number": "201-343-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 SUMMIT AVE",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "201-343-6360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKER",
        "first_name": "MINA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-26",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA10249900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.