Provider Demographics
NPI:1114949328
Name:SHULMAN, PAVEL (MD)
Entity Type:Individual
Prefix:
First Name:PAVEL
Middle Name:
Last Name:SHULMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5944
Mailing Address - Country:US
Mailing Address - Phone:516-599-1196
Mailing Address - Fax:
Practice Address - Street 1:312 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6875
Practice Address - Country:US
Practice Address - Phone:917-826-6551
Practice Address - Fax:718-701-5903
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212942207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925759Medicaid
NYA300019578Medicare PIN
NYG86939Medicare UPIN
NYA300019578Medicare PIN