=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265691059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL SHABTAI, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2008
-----------------------------------------------------
Last Update Date | 08/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17075 DEVONSHIRE ST SUITE 107
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91325-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-435-4789
-----------------------------------------------------
Fax | 818-363-5454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17075 DEVONSHIRE ST SUITE 107
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91325-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-435-4789
-----------------------------------------------------
Fax | 818-363-5454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / PHYSICIAN
-----------------------------------------------------
Name | DR. MICHAEL SHABTAI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-435-4789
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | A91300
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------