Healthcare Provider Details

I. General information

NPI: 1538277603
Provider Name (Legal Business Name): GERALD JAY SHEPPS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 11/24/2021
Certification Date: 03/11/2021
Deactivation Date: 10/24/2019
Reactivation Date: 11/04/2019

III. Provider practice location address

150 BROADWAY RM 1401
NEW YORK NY
10038-4378
US

IV. Provider business mailing address

150 BROADWAY RM 1401
NEW YORK NY
10038-4378
US

V. Phone/Fax

Practice location:
  • Phone: 212-233-2344
  • Fax: 212-732-9453
Mailing address:
  • Phone: 212-233-2344
  • Fax: 212-732-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number171891
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number171891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: