Provider Demographics
NPI:1568092005
Name:SHMUEL, JUSTIN IAN (BA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:IAN
Last Name:SHMUEL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 270TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1417
Mailing Address - Country:US
Mailing Address - Phone:917-470-5351
Mailing Address - Fax:
Practice Address - Street 1:300 KNOLLWOOD RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1217
Practice Address - Country:US
Practice Address - Phone:888-787-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic