Provider Demographics
NPI:1962504092
Name:SHOSHANY, STEVEN A (DC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:SHOSHANY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 BROADWAY STE 1210
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2624
Mailing Address - Country:US
Mailing Address - Phone:212-645-8151
Mailing Address - Fax:613-584-5825
Practice Address - Street 1:636 BROADWAY RM 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2623
Practice Address - Country:US
Practice Address - Phone:212-645-8151
Practice Address - Fax:613-584-5825
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008479-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X0C061Medicare ID - Type Unspecified