Provider Demographics
NPI:1124172184
Name:SHANSKI, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:SHANSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3828
Mailing Address - Country:US
Mailing Address - Phone:718-332-0080
Mailing Address - Fax:718-332-3365
Practice Address - Street 1:2610 E 18TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3622
Practice Address - Country:US
Practice Address - Phone:718-332-0080
Practice Address - Fax:718-332-3365
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691656Medicaid
NY11525192OtherCAQH