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General NPI Number Information
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NPI Number | 1407038565
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Entity Type | Organization
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Legal Business Name | DR. BRUCE SHAFFER
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 667 STONELEIGH AVE SUITE 111
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City | CARMEL
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State | NY
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Zip | 10512-2454
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Country | US
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Telephone | 845-278-8637
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Fax | 845-278-8695
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Provider Business Mailing Address
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Address Line | 667 STONELEIGH AVE SUITE 111
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City | CARMEL
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State | NY
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Zip | 10512-2454
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Country | US
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Telephone | 845-278-8637
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Fax | 845-278-8695
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. BRUCE M SHAFFER
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Credential | D.P.M.
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Telephone | 845-278-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N2987
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License Number State | NY
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