Healthcare Provider Details

I. General information

NPI: 1285849505
Provider Name (Legal Business Name): LARRY JUDAH SHEMEN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E 69TH ST SUITE 1D
NEW YORK NY
10021-5414
US

IV. Provider business mailing address

233 E 69TH ST SUITE 1D
NEW YORK NY
10021-5414
US

V. Phone/Fax

Practice location:
  • Phone: 212-472-8882
  • Fax: 212-472-3077
Mailing address:
  • Phone: 212-472-8882
  • Fax: 212-472-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number158776
License Number StateNY

VIII. Authorized Official

Name: DR. LARRY JUDAH SHEMEN
Title or Position: OWNER
Credential: MD
Phone: 212-472-8882