Healthcare Provider Details

I. General information

NPI: 1417927963
Provider Name (Legal Business Name): SHOSHANA CRAIG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SHOSHANA BELL O.D.

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8003
US

IV. Provider business mailing address

29 SCOTT DR
MELVILLE NY
11747-1013
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-5919
  • Fax:
Mailing address:
  • Phone: 516-996-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number006369-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: