Healthcare Provider Details

I. General information

NPI: 1073551537
Provider Name (Legal Business Name): LINDA ANNE SHOOKSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E FORDHAM RD
BRONX NY
10458-5049
US

IV. Provider business mailing address

524 OLD COUNTRY RD
PLAINVIEW NY
11803-6502
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-1900
  • Fax: 718-563-4039
Mailing address:
  • Phone: 516-931-3988
  • Fax: 516-931-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number157966
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: