1326030305 NPI number — NEAL H SHUREN MD

Table of content: NEAL H SHUREN MD (NPI 1326030305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326030305 NPI number — NEAL H SHUREN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHUREN
Provider First Name:
NEAL
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326030305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 AIRPORT EXECUTIVE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANUET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10954-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-356-2900
Provider Business Mailing Address Fax Number:
845-356-7797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
327 ROUTE 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIRMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-356-2900
Provider Business Practice Location Address Fax Number:
845-356-7797
Provider Enumeration Date:
08/17/2005

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: 207XS0106X , with the licence number:  187591 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 187591 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01672673 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5777050 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0D0557 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 570F42 . This is a "EMPIRE BCBS (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P582639 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0029106 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0763533 . This is a "AETNA HMO#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132721370 . This is a "TAX ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 570F41 . This is a "EMPIRE BCBS (STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 570F43 . This is a "EMPIRE BCBS (AIRMONT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 603445 . This is a "MVP (MONROE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200027903 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 603444 . This is a "MVP (AIRMONT/STONY POINT)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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