Healthcare Provider Details

I. General information

NPI: 1750310058
Provider Name (Legal Business Name): DEBORA DAVIDOVNA SHPOLYANSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 E 174TH ST
BRONX NY
10457-7152
US

IV. Provider business mailing address

80 VAN CORTLANDT PARK S
BRONX NY
10463-3039
US

V. Phone/Fax

Practice location:
  • Phone: 718-299-6910
  • Fax: 718-299-4633
Mailing address:
  • Phone: 718-884-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number237687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: