Individual
JOHN E SHALLAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1930 DEER PARK AVE, DEER PARK, NY 11729-3328
(631) 254-5900
(631) 392-0948
Mailing address
1345 RXR PLZ FL 13, UNIONDALE, NY 11556-1301
(516) 453-0435
(646) 846-3283
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
219990-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02322681
—
NY
Enumeration date
05/22/2007
Last updated
12/06/2019
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