Healthcare Provider Details

I. General information

NPI: 1659301125
Provider Name (Legal Business Name): JOSEPH SHAMS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/11/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 116TH ST STE 400
NEW YORK NY
10029-1776
US

IV. Provider business mailing address

182 INDUSTRIAL RD
GLEN ROCK PA
17327-8626
US

V. Phone/Fax

Practice location:
  • Phone: 646-362-3178
  • Fax:
Mailing address:
  • Phone: 717-759-5148
  • Fax: 717-759-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number187268
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number187268
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number187268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: