Healthcare Provider Details

I. General information

NPI: 1295796134
Provider Name (Legal Business Name): JAMES TUZIO SHAMMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAST RIDGEWOOD AVE EAST WING - 2ND FLOOR
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

1200 EAST RIDGEWOOD AVE EAST WING - 2ND FLOOR
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-0868
  • Fax: 201-493-0797
Mailing address:
  • Phone: 201-444-0868
  • Fax: 201-493-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA62162
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: