Provider Demographics
NPI:1548373855
Name:SHAKIN, ERIC P (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:SHAKIN
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 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-466-0390
Mailing Address - Fax:516-829-0520
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-466-0390
Practice Address - Fax:516-829-0520
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159286207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01538247Medicaid
NYW8E001Medicare PIN
NY01556Medicare PIN
NY44I491Medicare ID - Type Unspecified
NY180021579Medicare PIN
C34431Medicare UPIN
NYCF7254Medicare PIN
NY01538247Medicaid
NY01556KMedicare PIN
NY180022116Medicare PIN