Basic Information
| Provider Information | |||||||||
| NPI: | 1083696181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAIOVA | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 YORK AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100216007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126398496 | ||||||||
| FaxNumber: | 2127173081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BROOKDALE PLAZA | ||||||||
| Address2: | DEPT OF MEDICINE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112121121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182408234 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 193814 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 01777384 | 05 | NY | MEDICAID |