Healthcare Provider Details

I. General information

NPI: 1699800466
Provider Name (Legal Business Name): BARBARA SHORTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 EAST 75TH ST
NEW YORK NY
10021
US

IV. Provider business mailing address

128 EAST 75TH ST
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-6222
  • Fax: 207-568-0322
Mailing address:
  • Phone: 212-737-6222
  • Fax: 207-568-0322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number145561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: