Provider Demographics
NPI:1417050865
Name:LAWRENCE SHADEROWFSKY MD PC
Entity Type:Organization
Organization Name:LAWRENCE SHADEROWFSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PC
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADEROWFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-535-4728
Mailing Address - Street 1:35 EAST 85TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-535-4728
Mailing Address - Fax:201-944-1250
Practice Address - Street 1:35 E 85TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0954
Practice Address - Country:US
Practice Address - Phone:212-535-4728
Practice Address - Fax:201-944-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08651712084P0800X
NJ25MA051501002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY264481Medicare PIN