1265640924 NPI number — DR. RICKIE SUE SHUSTER PSYD

Table of content: DR. RICKIE SUE SHUSTER PSYD (NPI 1265640924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265640924 NPI number — DR. RICKIE SUE SHUSTER PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUSTER
Provider First Name:
RICKIE
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHUSTER
Provider Other First Name:
REBECCA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265640924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 WEST 16TH ST
Provider Second Line Business Mailing Address:
APT 12H
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10011-6206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-741-1121
Provider Business Mailing Address Fax Number:
212-475-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 EAST 11TH ST
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-475-1669
Provider Business Practice Location Address Fax Number:
212-475-2116
Provider Enumeration Date:
05/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  010393 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)