Provider Demographics
NPI:1275319808
Name:SHALAM, YITZCHAK ISAAC
Entity type:Individual
Prefix:
First Name:YITZCHAK
Middle Name:ISAAC
Last Name:SHALAM
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 1:1538 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7004
Mailing Address - Country:US
Mailing Address - Phone:347-525-4560
Mailing Address - Fax:
Practice Address - Street 1:1538 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7004
Practice Address - Country:US
Practice Address - Phone:347-525-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program