Provider Demographics
NPI:1245490457
Name:MARTIN I SCHUSTER MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARTIN I SCHUSTER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-0747
Mailing Address - Street 1:5000 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1793
Mailing Address - Country:US
Mailing Address - Phone:818-788-0747
Mailing Address - Fax:818-788-0742
Practice Address - Street 1:5000 VAN NUYS BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1793
Practice Address - Country:US
Practice Address - Phone:818-788-0747
Practice Address - Fax:818-788-0742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41041305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID
CAA41041Medicare PIN