Healthcare Provider Details

I. General information

NPI: 1447293865
Provider Name (Legal Business Name): IRENE AUDREY SCHULMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 147TH ST
FLUSHING NY
11355-1736
US

IV. Provider business mailing address

110 HAUPPAUGE RD
COMMACK NY
11725-4403
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-0900
  • Fax: 718-886-5659
Mailing address:
  • Phone: 631-499-2642
  • Fax: 631-588-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number167342
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number167342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: