Healthcare Provider Details

I. General information

NPI: 1548243363
Provider Name (Legal Business Name): RICHARD N SHIFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE YNHH BASEMENT - PEDIATRICS
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

789 HOWARD AVE YNHH BASEMENT - PEDIATRICS
NEW HAVEN CT
06519-1304
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2470
  • Fax: 203-688-7274
Mailing address:
  • Phone: 203-688-2470
  • Fax: 203-688-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033241
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: