MEDICARE: DR. BRUCE MARSHALL SHAFFER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N2987	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346233194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE MARSHALL SHAFFER DPM

Provider Business Mailing Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 111
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	845-278-8637
Fax Number	:	845-278-8695

Provider Business Practice Location Address
First Line	:	667 STONELEIGH AVE
Second Line	:	SUITE 111
City	:	CARMEL
State	:	NY
Zip	:	10512-2454
Country	:	US
Telephone Number	:	845-278-8637
Fax Number	:	845-278-8695

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	04/02/2008

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