Provider Demographics
NPI:1184938409
Name:TABACK, SHELDON J (MSOTR)
Entity type:Individual
Prefix:MR
First Name:SHELDON
Middle Name:J
Last Name:TABACK
Suffix:
Gender:M
Credentials:MSOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BRYANT AVE APT 3BB
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1934
Mailing Address - Country:US
Mailing Address - Phone:914-772-4007
Mailing Address - Fax:
Practice Address - Street 1:90 BRYANT AVE APT 3BB
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1934
Practice Address - Country:US
Practice Address - Phone:914-772-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001098-1171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001098-1OtherOCCUPATIONAL THERAPY