Provider Demographics
NPI:1902841992
Name:SHULMAN, BRETT C (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:C
Last Name:SHULMAN
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 1:20 HAGEN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2664
Mailing Address - Country:US
Mailing Address - Phone:585-922-9770
Mailing Address - Fax:585-922-9733
Practice Address - Street 1:20 HAGEN DR STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2664
Practice Address - Country:US
Practice Address - Phone:585-922-9770
Practice Address - Fax:585-922-9733
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152624207N00000X
NHLT4168207N00000X
MN70092207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026872101OtherUNIVERA #
NY0314096OtherIHA #
NYP010152624OtherBLUE CHOICE #
NY01684757Medicaid
NYP00142333OtherMEDICARE RAILROAD #
NY102424APOtherPREFERRED CARE #
NY152624-3WOtherWORKERS COMP #
NY7891OtherSIDNEY HILLMAN #
NY00026872101OtherUNIVERA #
NYP010152624OtherBLUE CHOICE #
NY152624-3WOtherWORKERS COMP #
NYDD6823Medicare ID - Type Unspecified