Provider Demographics
NPI:1235326554
Name:RICHARD SHANIN DPM PC
Entity Type:Organization
Organization Name:RICHARD SHANIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHANIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-294-5510
Mailing Address - Street 1:53 W MAIN ST # 307
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1916
Mailing Address - Country:US
Mailing Address - Phone:845-294-5510
Mailing Address - Fax:845-774-1650
Practice Address - Street 1:53 W MAIN ST
Practice Address - Street 2:POB 307
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1916
Practice Address - Country:US
Practice Address - Phone:845-294-5510
Practice Address - Fax:845-774-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00418635Medicaid
NYT50952Medicare UPIN
NYP33001Medicare PIN