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General NPI Number Information
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NPI Number | 1568092005
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Entity Type | Individual
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Provider Name | JUSTIN IAN SHMUEL B.A
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Gender | Male
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 300 KNOLLWOOD RD
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City | WHITE PLAINS
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State | NY
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Zip | 10607-1217
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Country | US
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Telephone | 888-787-6267
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Fax |
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Provider Business Mailing Address
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Address Line | 7625 270TH ST
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1417
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Country | US
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Telephone | 917-470-5351
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Fax |
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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 | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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