Healthcare Provider Details

I. General information

NPI: 1285680348
Provider Name (Legal Business Name): WILLIAM SHESTAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 204
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-2727
  • Fax: 516-663-8549
Mailing address:
  • Phone: 516-576-5812
  • Fax: 516-576-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number212656-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: