Provider Demographics
NPI:1427096635
Name:SHUSTER, HARVEY LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:LAWRENCE
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 S RIDGE ST
Mailing Address - Street 2:SUITE LL-12
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2867
Mailing Address - Country:US
Mailing Address - Phone:914-935-9009
Mailing Address - Fax:914-935-0737
Practice Address - Street 1:90 S RIDGE ST
Practice Address - Street 2:SUITE LL-12
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2867
Practice Address - Country:US
Practice Address - Phone:914-935-9009
Practice Address - Fax:914-935-0737
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0311301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD6C593Medicare ID - Type Unspecified
NYU36300Medicare UPIN
NYD9W511Medicare ID - Type Unspecified