Provider Demographics
NPI:1629011317
Name:SHIFFMAN, GARY ALLAN (PT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLAN
Last Name:SHIFFMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5792
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:201-751-1680
Practice Address - Street 1:300 COMMERCENTER STATE HWY. 17 SOUTH
Practice Address - Street 2:SUITE G
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430
Practice Address - Country:US
Practice Address - Phone:201-529-8322
Practice Address - Fax:201-529-8377
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA003334002251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ001504Medicare ID - Type UnspecifiedP.T. IN INDEP. PRACTICE