Provider Demographics
NPI:1538277603
Name:SHEPPS, GERALD JAY (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:JAY
Last Name:SHEPPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADWAY RM 1401
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4378
Mailing Address - Country:US
Mailing Address - Phone:212-233-2344
Mailing Address - Fax:212-732-9453
Practice Address - Street 1:150 BROADWAY RM 1401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4378
Practice Address - Country:US
Practice Address - Phone:212-233-2344
Practice Address - Fax:212-732-9453
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-11-24
Deactivation Date:2019-10-24
Deactivation Code:
Reactivation Date:2019-11-04
Provider Licenses
StateLicense IDTaxonomies
NY171891207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01367573Medicaid
NY01367573Medicaid