Healthcare Provider Details

I. General information

NPI: 1346297496
Provider Name (Legal Business Name): MIDTOWN INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E 58TH ST SUITE 301
NEW YORK NY
10022-1236
US

IV. Provider business mailing address

133 E 58TH ST SUITE 301
NEW YORK NY
10022-1236
US

V. Phone/Fax

Practice location:
  • Phone: 212-980-0011
  • Fax: 212-980-0019
Mailing address:
  • Phone: 212-980-0011
  • Fax: 212-980-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number233206
License Number StateNY

VIII. Authorized Official

Name: DR. STEPHEN GERARD SHAW
Title or Position: PRINICIPAL OFFICER
Credential: MD
Phone: 212-980-0011