Healthcare Provider Details

I. General information

NPI: 1225036676
Provider Name (Legal Business Name): ALLEN SHUMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 WESTCHESTER AVE
BRONX NY
10472-3007
US

IV. Provider business mailing address

1815 WESTCHESTER AVE
BRONX NY
10472-3007
US

V. Phone/Fax

Practice location:
  • Phone: 718-893-8866
  • Fax: 718-904-8601
Mailing address:
  • Phone: 718-893-8866
  • Fax: 718-904-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number002268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: