Healthcare Provider Details

I. General information

NPI: 1023008554
Provider Name (Legal Business Name): HARVEY SHANDLER DMD,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 FRANKLIN AVE
PEARL RIVER NY
10965-2505
US

IV. Provider business mailing address

12 BRIARWOOD DR
NEW CITY NY
10956-6110
US

V. Phone/Fax

Practice location:
  • Phone: 845-735-5663
  • Fax:
Mailing address:
  • Phone: 845-634-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number32764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: