Provider Demographics
NPI:1629011317
Name:SHIFFMAN, GARY ALLAN (PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLAN
Last Name:SHIFFMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1322
Mailing Address - Country:US
Mailing Address - Phone:201-446-3817
Mailing Address - Fax:201-943-1183
Practice Address - Street 1:300 COMMERCENTER STATE HWY. 17 SOUTH
Practice Address - Street 2:SUITE G
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-529-8322
Practice Address - Fax:201-529-8377
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA003334002251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001504Medicare ID - Type UnspecifiedP.T. IN INDEP. PRACTICE