Provider Demographics
NPI:1215136692
Name:SHOOBE, JUDITH ELLEN (DO)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:SHOOBE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 W 125TH ST
Mailing Address - Street 2:TOURO COLLEGE OF OSTEOPATHIC MEDICINE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4402
Mailing Address - Country:US
Mailing Address - Phone:212-851-1199
Mailing Address - Fax:
Practice Address - Street 1:55 E 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1815
Practice Address - Country:US
Practice Address - Phone:212-851-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197118-1204D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM