MEDICARE: JACALYN HOPE SHAFER M.D.

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	208000000X	Pediatrics Physician	183406-1	NY

General Provider Information

NPI Number	:	1902919517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACALYN HOPE SHAFER M.D.

Provider Business Mailing Address
First Line	:	320 CENTRAL PARK W
Second Line	:	#1FG
City	:	NEW YORK
State	:	NY
Zip	:	10025-7659
Country	:	US
Telephone Number	:	212-579-4800
Fax Number	:	212-579-9250

Provider Business Practice Location Address
First Line	:	320 CENTRAL PARK W
Second Line	:	#1FG
City	:	NEW YORK
State	:	NY
Zip	:	10025-7659
Country	:	US
Telephone Number	:	212-579-4800
Fax Number	:	212-579-9250

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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