Provider Demographics
NPI:1437301272
Name:MARTIN SHANSKY MD PA
Entity Type:Organization
Organization Name:MARTIN SHANSKY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-567-4934
Mailing Address - Street 1:6278 N FEDERAL HWY
Mailing Address - Street 2:SUITE 113
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1916
Mailing Address - Country:US
Mailing Address - Phone:954-567-4934
Mailing Address - Fax:954-564-1536
Practice Address - Street 1:2881 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1813
Practice Address - Country:US
Practice Address - Phone:954-567-4934
Practice Address - Fax:954-564-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBI983Medicare PIN