Provider Demographics
NPI:1699878736
Name:SHEMEN, LARRY JUDAH (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JUDAH
Last Name:SHEMEN
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 1:233 EAST 69TH STREET
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-472-8882
Mailing Address - Fax:212-472-3077
Practice Address - Street 1:233 E 69TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5414
Practice Address - Country:US
Practice Address - Phone:212-472-8882
Practice Address - Fax:212-472-3077
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158776207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00838179Medicaid
A61221Medicare UPIN
NY21D391Medicare ID - Type Unspecified