Provider Demographics
NPI:1073542643
Name:SHIGOL, ALLA (MD)
Entity Type:Individual
Prefix:
First Name:ALLA
Middle Name:
Last Name:SHIGOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2308
Mailing Address - Country:US
Mailing Address - Phone:201-483-3716
Mailing Address - Fax:
Practice Address - Street 1:151 MAUJER ST
Practice Address - Street 2:WILLIAMSBURG CHC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1220
Practice Address - Country:US
Practice Address - Phone:718-387-2211
Practice Address - Fax:718-387-6655
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics