MEDICARE: EDWARD SHALTS MD

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	2084P0800X	Psychiatry Physician	209237	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	:	1518035732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD SHALTS MD

Provider Business Mailing Address
First Line	:	725 RIVER RD
Second Line	:	SUITE 32-79
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1171
Country	:	US
Telephone Number	:	646-301-2578
Fax Number	:

Provider Business Practice Location Address
First Line	:	9520 63RD RD STE H
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-1145
Country	:	US
Telephone Number	:	718-864-2120
Fax Number	:	888-603-6374

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	01/28/2021

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