Healthcare Provider Details

I. General information

NPI: 1740514116
Provider Name (Legal Business Name): DAVE SHUKLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 KINGS HWY ORTHOPEDIC SURGERY
BROOKLYN NY
11234
US

IV. Provider business mailing address

150 E 42ND ST FL 5
NEW YORK NY
10017-5612
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-3000
  • Fax:
Mailing address:
  • Phone: 949-500-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA141910
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number276765
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number60338
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: