Provider Demographics
NPI:1285849505
Name:LARRY JUDAH SHEMEN, M.D., P.C.
Entity Type:Organization
Organization Name:LARRY JUDAH SHEMEN, M.D., P.C.
Other - Org Name:LARRY JUDAH SHEMEN MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JUDAH
Authorized Official - Last Name:SHEMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-472-8882
Mailing Address - Street 1:233 E 69TH ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5414
Mailing Address - Country:US
Mailing Address - Phone:212-472-8882
Mailing Address - Fax:212-472-3077
Practice Address - Street 1:233 E 69TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5414
Practice Address - Country:US
Practice Address - Phone:212-472-8882
Practice Address - Fax:212-472-3077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARRY JUDAH SHEMEN, M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158776174400000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00838179Medicaid
NY60616Medicare ID - Type UnspecifiedMEDICARE-GHI
NY00838179Medicaid
NYA61221Medicare UPIN