Healthcare Provider Details

I. General information

NPI: 1629149000
Provider Name (Legal Business Name): PAUL A SHURIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMG - CFCC 1621 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

41 TERRACE DR
NYACK NY
10960-4219
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8059
  • Fax:
Mailing address:
  • Phone: 718-405-8059
  • Fax: 718-405-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number178887
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: