=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740357482
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILEEN RUTHE SHEPARD P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 08/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 E 69TH ST SUITE 1K
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-5452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-772-1904
-----------------------------------------------------
Fax | 212-772-1970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 174 BULL PATH
-----------------------------------------------------
City | EAST HAMPTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11937-4601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-750-1080
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 003162
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------