Provider Demographics
NPI:1821112095
Name:J. L. SHEFTS & I. C. MEDWID PTRS
Entity Type:Organization
Organization Name:J. L. SHEFTS & I. C. MEDWID PTRS
Other - Org Name:CENTRAL PARK CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:MEDWID
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-873-8400
Mailing Address - Street 1:50 WEST 72ND STREET
Mailing Address - Street 2:SUITE C5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4199
Mailing Address - Country:US
Mailing Address - Phone:212-873-8400
Mailing Address - Fax:212-362-0119
Practice Address - Street 1:50 WEST 72ND STREET
Practice Address - Street 2:SUITE C5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4199
Practice Address - Country:US
Practice Address - Phone:212-873-8400
Practice Address - Fax:212-362-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
NYX004663-1111N00000X
NYX005256-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty