Healthcare Provider Details

I. General information

NPI: 1366652349
Provider Name (Legal Business Name): JAMES J. SHEN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 COLON AVE
STATEN ISLAND NY
10308-1419
US

IV. Provider business mailing address

453 COLON AVE
STATEN ISLAND NY
10308-1419
US

V. Phone/Fax

Practice location:
  • Phone: 718-948-2121
  • Fax: 718-967-1281
Mailing address:
  • Phone: 718-948-2121
  • Fax: 718-967-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number116662
License Number StateNY

VIII. Authorized Official

Name: DR. JAMES JUH SHEN
Title or Position: DOCTOR
Credential: M.D.
Phone: 718-948-2121