Healthcare Provider Details

I. General information

NPI: 1669558516
Provider Name (Legal Business Name): ELLEN E SHATZKIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - DEPT. OF PEDIATRICS 1825 EASTCHESTER ROAD
BRONX NY
10461
US

IV. Provider business mailing address

53 BEVERLY RD
WHITE PLAINS NY
10605-3305
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4032
  • Fax:
Mailing address:
  • Phone: 718-904-4032
  • Fax: 718-904-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number004031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: