Basic Information
| Provider Information | |||||||||
| NPI: | 1841294584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHULMAN | ||||||||
| FirstName: | JULIUS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 E GATE BLVD | ||||||||
| Address2: | STE 111 | ||||||||
| City: | GARDEN CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115302136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168045200 | ||||||||
| FaxNumber: | 5162406540 | ||||||||
| Practice Location | |||||||||
| Address1: | 229 E 79TH ST | ||||||||
| Address2: | STE 1L | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100210866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128616200 | ||||||||
| FaxNumber: | 2122886545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/15/2006 | ||||||||
| NPIReactivationDate: | 03/23/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 107626 | NY | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 00189684 | 05 | NY | MEDICAID |