Basic Information
| Provider Information | |||||||||
| NPI: | 1528379062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABEENDRAN | ||||||||
| FirstName: | SHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 726 | ||||||||
| Address2: | |||||||||
| City: | LARCHMONT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105380726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015672277 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 CANNON PL | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104634302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187968100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 08/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 274554 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.