Provider Demographics
NPI:1205288305
Name:JOHNSHAOMD
Entity type:Organization
Organization Name:JOHNSHAOMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-564-1215
Mailing Address - Street 1:289 N PLANK RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1790
Mailing Address - Country:US
Mailing Address - Phone:845-564-1215
Mailing Address - Fax:845-553-6102
Practice Address - Street 1:289 N PLANK RD
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-1790
Practice Address - Country:US
Practice Address - Phone:845-564-1215
Practice Address - Fax:845-553-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232955-1207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty