Provider Demographics
NPI:1932213824
Name:SHANI, ERAN I (MD)
Entity Type:Individual
Prefix:
First Name:ERAN
Middle Name:I
Last Name:SHANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SAYBROOK RD
Mailing Address - Street 2:MIDDLESEX CARDIOLOGY ASSOCIATES
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4747
Mailing Address - Country:US
Mailing Address - Phone:860-347-4258
Mailing Address - Fax:860-704-5924
Practice Address - Street 1:420 SAYBROOK RD
Practice Address - Street 2:MIDDLESEX CARDIOLOGY ASSOCIATES
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4747
Practice Address - Country:US
Practice Address - Phone:860-347-4258
Practice Address - Fax:860-704-5924
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043189207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431890Medicaid
3803597OtherAETNA
001431890-01OtherEDS/BLUECARE
043189OtherCT
010043189CT01OtherANTHEM
61044837OtherUNITED HC
P3592644OtherOXFORD
2521811OtherCIGNA
2V7057OtherHEALTH NET
060001658Medicare ID - Type Unspecified
CT001431890Medicaid