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General NPI Number Information
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NPI Number | 1649358110
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Entity Type | Organization
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Legal Business Name | NORTHEAST UROLOGICAL SPECIALISTS, P.C.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 63 SHAKER RD SUITE 202 ALBANY MEMORIAL PROFESSIONAL BLDG
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City | ALBANY
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State | NY
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Zip | 12204-1030
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Country | US
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Telephone | 518-434-1283
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Fax | 518-434-0730
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Provider Business Mailing Address
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Address Line | 63 SHAKER RD SUITE 202 ALBANY MEMORIAL PROFESSIONAL
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City | ALBANY
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State | NY
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Zip | 12204-1030
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Country | US
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Telephone | 518-434-1283
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Fax | 518-434-0730
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. BARRY A SHUMAN
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Credential | MD
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Telephone | 518-434-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 199463
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License Number State | NY
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