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General NPI Number Information
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NPI Number | 1497720536
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Entity Type | Individual
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Provider Name | IDA K ALTSHULER M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 27 NEW DORP LN
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City | STATEN ISLAND
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State | NY
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Zip | 10306-2322
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Country | US
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Telephone | 718-667-3597
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Fax | 718-667-3590
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Provider Business Mailing Address
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Address Line | 4190 BEDFORD AVE
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City | BROOKLYN
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State | NY
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Zip | 11229-4956
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Country | US
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Telephone | 718-667-3800
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Fax | 718-980-9281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 235960-1
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License Number State | NY
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