Provider Demographics
NPI:1518944388
Name:SHOUM, STEVEN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:SHOUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8406
Mailing Address - Country:US
Mailing Address - Phone:516-524-2066
Mailing Address - Fax:
Practice Address - Street 1:345 E SHORE DR
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8406
Practice Address - Country:US
Practice Address - Phone:516-524-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138929207L00000X
NY1389292207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
112999600OtherMDNY
112999600OtherMULTIPLAN
3583944OtherAETNA HMO
P715172OtherOXFORD
NY00909691Medicaid
7T1291OtherBCBS AND SENIOR PLAN
CM0035OtherRAILROAD MEDICARE
112999600OtherHORIZON
112999600OtherEMPIRE PLAN GVT
112999600OtherMAGNACARE
112999600Other1199 W MULTIPLAN LOGO
139039OtherVYTRA
4520213OtherAETNA PPO
89411OtherGHI HMO
112999600OtherUNITED HEALTHCARE
5352149OtherCIGNA
5396870OtherGHI PPO
3583944OtherAETNA HMO
4520213OtherAETNA PPO