Healthcare Provider Details

I. General information

NPI: 1528213873
Provider Name (Legal Business Name): SHIFRA DEUTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2008
Last Update Date: 11/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914 15TH AVE
BROOKLYN NY
11218-4410
US

IV. Provider business mailing address

3914 15TH AVE
BROOKLYN NY
11218-4410
US

V. Phone/Fax

Practice location:
  • Phone: 718-853-9700
  • Fax: 718-853-5533
Mailing address:
  • Phone: 718-853-9700
  • Fax: 718-853-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number059070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: