Provider Demographics
NPI:1679606446
Name:SHALIT, SHIMON (MD)
Entity type:Individual
Prefix:DR
First Name:SHIMON
Middle Name:
Last Name:SHALIT
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 1:12 GREENRIDGE AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1238
Mailing Address - Country:US
Mailing Address - Phone:914-948-3128
Mailing Address - Fax:914-948-6809
Practice Address - Street 1:12 GREENRIDGE AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1238
Practice Address - Country:US
Practice Address - Phone:914-948-3128
Practice Address - Fax:914-948-6809
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095582-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC09489Medicare UPIN