Basic Information
| Provider Information | |||||||||
| NPI: | 1801050117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHNAIDMAN | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 E STATE ST | ||||||||
| Address2: | PO BOX1250 | ||||||||
| City: | GLOVERSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120781203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838620 | ||||||||
| FaxNumber: | 5188835653 | ||||||||
| Practice Location | |||||||||
| Address1: | 4104 STATE HIGHWAY 30 | ||||||||
| Address2: | |||||||||
| City: | AMSTERDAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120106202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188838620 | ||||||||
| FaxNumber: | 5188835653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 01/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 247590 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03068336 | 05 | NY | MEDICAID | 10400487 | 01 | NY | CDPHP | OTHER | 6022479 | 01 | NY | MVP HEALTHCARE | OTHER | 000418266001 | 01 | NY | BSH NE NY | OTHER |