Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | X010168-1 | NY |
Y | 111NI0900X | Internist | X010168-1 | NY |
N | 111NN1001X | Nutrition | 001952 | CT |
N | 111NN1001X | Nutrition | 38MC00632700 | NJ |
N | 111NN1001X | Nutrition | X010168-1 | NY |
NPI | 1588741482 |
---|---|
Provider Name | Dr. Gregory M Shure |
First Address | New York, NY 10010-1600 |
Second Address | New York, NY 10010-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 04/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201365799 | (02) | NY |
P3430261 | OXFORD ID # (01) | NY |