Provider Demographics
NPI:1487987780
Name:NATHANIEL SHAFER, M.D., P.C.
Entity type:Organization
Organization Name:NATHANIEL SHAFER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-289-7120
Mailing Address - Street 1:10 E 85TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0412
Mailing Address - Country:US
Mailing Address - Phone:212-289-7120
Mailing Address - Fax:212-879-9364
Practice Address - Street 1:10 E 85TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0412
Practice Address - Country:US
Practice Address - Phone:212-289-7120
Practice Address - Fax:212-879-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076953202C00000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001-04921Medicaid
NY076953-9BOtherIME
NYA61626Medicare UPIN
NY254971Medicare PIN