MEDICARE: LARRY JUDAH SHEMEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	158776	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699878736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY JUDAH SHEMEN MD

Provider Business Mailing Address
First Line	:	233 EAST 69TH STREET
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10021
Country	:	US
Telephone Number	:	212-472-8882
Fax Number	:	212-472-3077

Provider Business Practice Location Address
First Line	:	233 E 69TH ST
Second Line	:	SUITE 1D
City	:	NEW YORK
State	:	NY
Zip	:	10021-5414
Country	:	US
Telephone Number	:	212-472-8882
Fax Number	:	212-472-3077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	05/29/2013

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