Healthcare Provider Details

I. General information

NPI: 1528146784
Provider Name (Legal Business Name): ALAN L SHANSKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

99 DARLING AVE
NEW ROCHELLE NY
10804-1221
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2450
  • Fax:
Mailing address:
  • Phone: 718-741-2450
  • Fax: 718-920-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number109457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: