MEDICARE: DR. SHEVAUN K KIRSCHBAUM P.T., D.P.T.

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	225100000X	Physical Therapist	40QA01385800	NJ
2	225100000X	Physical Therapist	032774	NY

General Provider Information

NPI Number	:	1720359136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEVAUN K KIRSCHBAUM P.T., D.P.T.

Provider Business Mailing Address
First Line	:	105 SHAD ROW FL 2
Second Line	:
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	845-359-0220
Fax Number	:	201-660-7303

Provider Business Practice Location Address
First Line	:	105 SHAD ROW FL 2
Second Line	:
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	845-359-0220
Fax Number	:	201-660-7303

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

Provider Enumeration Date	:	01/17/2012
Last Update Date	:	12/31/2019

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