1538144639 NPI number — STEVEN SHANKMAN MD

Table of content: STEVEN SHANKMAN MD (NPI 1538144639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538144639 NPI number — STEVEN SHANKMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHANKMAN
Provider First Name:
STEVEN
Provider Middle Name:
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:
1538144639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23625 COMMERCE PARK
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-255-5701
Provider Business Mailing Address Fax Number:
216-255-5701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 W 89TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10024-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-255-5700
Provider Business Practice Location Address Fax Number:
216-255-5701
Provider Enumeration Date:
12/12/2005

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: 2085R0202X , with the licence number:  150508 , 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)

  • Identifier: 34195845110024 . This is a "TRICARE WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 341958451020 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 71R36 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1016624150001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12317801 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 209756897 . This is a "TRICARE SOUTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2510769 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807443900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00163856 . This is a "RXR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 009355700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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