Healthcare Provider Details

I. General information

NPI: 1871748103
Provider Name (Legal Business Name): NORBERT SHTAYNBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SEAVIEW AVE
STATEN ISLAND NY
10305-3401
US

IV. Provider business mailing address

97 NEW DORP LN SUITE A
STATEN ISLAND NY
10306-2364
US

V. Phone/Fax

Practice location:
  • Phone: 718-987-5940
  • Fax: 718-667-9708
Mailing address:
  • Phone: 718-876-6220
  • Fax: 718-876-5969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number253279
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number253279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: