Healthcare Provider Details

I. General information

NPI: 1194123752
Provider Name (Legal Business Name): RICHARD SHULMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD SUITE 208
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

100 MANETTO HILL RD SUITE 208
PLAINVIEW NY
11803-1311
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number044044
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: