Provider Demographics
NPI:1033309729
Name:SHULMAN, JENNY (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 23RD AVE
Mailing Address - Street 2:#F7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3349
Mailing Address - Country:US
Mailing Address - Phone:347-723-7904
Mailing Address - Fax:
Practice Address - Street 1:263 7TH AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3689
Practice Address - Country:US
Practice Address - Phone:718-780-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63014629174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1CA4Q4AC1Medicare PIN