Healthcare Provider Details

I. General information

NPI: 1568948461
Provider Name (Legal Business Name): JANET SHEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
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 Number2227641
License Number StateNY

VIII. Authorized Official

Name: JANET SHEN LIM
Title or Position: OWNER
Credential: MD
Phone: 718-948-2121