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Individual
SHAI NYI
Active
Individual
SHAI NYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-085947
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085947
—
IL
01
—
DP5951
RR GROUP # COLLEGE AVE
—
01
—
IL2613
MEDICARE GROUP PTAN
IL
01
—
P00823122
RR INDIVIDUAL # COLLEGE AVE
—
Enumeration date
10/01/2006
Last updated
06/25/2010
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