Provider Demographics
NPI:1407964505
Name:SHEPARD, RICHARD JOSHUA (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOSHUA
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5107
Mailing Address - Country:US
Mailing Address - Phone:212-496-9620
Mailing Address - Fax:212-496-2768
Practice Address - Street 1:140 W 69TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5107
Practice Address - Country:US
Practice Address - Phone:212-496-9620
Practice Address - Fax:212-496-2768
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112735566Other1199
NY4276810OtherAETNA USHC PPO
NY950121OtherPHS
NY112735566OtherPHCS
NY125498OtherHIP
NY5900725OtherGHI
NYSR5498OtherATLANTIS
NY751078OtherUNITED HEALTHCARE
NY482478OtherAETNA USHC HMO
NYNP361OtherOXFORD HEALTH PLANS
NY38360OtherCIGNA
NY38360OtherCIGNA
NY112735566OtherPHCS