Healthcare Provider Details

I. General information

NPI: 1316873177
Provider Name (Legal Business Name): SHIMON DRUMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 54TH ST APT 4B
BROOKLYN NY
11219-4227
US

IV. Provider business mailing address

1466 54TH ST APT 4B
BROOKLYN NY
11219-4227
US

V. Phone/Fax

Practice location:
  • Phone: 917-772-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number000653850645
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: