Healthcare Provider Details

I. General information

NPI: 1518068022
Provider Name (Legal Business Name): BRUCE STUART SHULMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 COMMUNITY DRIVE LOWER LEVEL STE. 3
MANHASSET NY
11030
US

IV. Provider business mailing address

444 COMMUNITY DRIVE LOWER LEVEL STE. 3
MANHASSET NY
11030
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-1600
  • Fax: 516-365-2181
Mailing address:
  • Phone: 516-365-1600
  • Fax: 516-365-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number135234
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier58G78
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE BLUE CROSS/BLUE SH
# 2
IdentifierAP450
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD HEALTHPLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: