Provider Demographics
NPI:1083696181
Name:SHAIOVA, LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SHAIOVA
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 1:1275 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-8496
Mailing Address - Fax:212-717-3081
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1121
Practice Address - Country:US
Practice Address - Phone:718-240-8234
Practice Address - Fax:718-240-5808
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193814208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777384Medicaid
G16609Medicare UPIN
NY21Z401Medicare ID - Type Unspecified