Provider Demographics
NPI:1902984115
Name:SHOENFELD, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:SHOENFELD
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 1:927 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3334
Mailing Address - Country:US
Mailing Address - Phone:516-623-6095
Mailing Address - Fax:516-623-6097
Practice Address - Street 1:927 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3334
Practice Address - Country:US
Practice Address - Phone:516-623-6095
Practice Address - Fax:516-623-6097
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY47A211Medicare PIN
NYB14956Medicare UPIN