Individual provider Active NPI

Christopher Michael Shutty, D.O.

  • Cytopathology Physician
  • Brooklyn, NY
National Provider Identifier
1265668776
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cytopathology PhysicianTaxonomy code 207ZC0500X
License
257416 Issued in NY
Practice address
904 49TH St
Brooklyn, NY 11219-2922
Phone
(718) 853-6433
Fax
(718) 853-6449
NPI assigned
Jun 10, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 229422 MA
Cytopathology Physician 207ZC0500X 257416 NY Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 257416 NY

Addresses

Primary practice location

904 49TH St
Brooklyn, NY 11219-2922

Mailing address

1125 Banner Ave
Apt. 10C
Brooklyn, NY 11235-5260
Phone (718) 853-6433

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150130000152 NY Practitioner - Pathology 9335463959 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
257416NYMDCytopathology Physician
229422MAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Minkowitz Pathology Cytopathology CurrentSince Jul 7, 2014 Accepting new patients

Locations

904 49th St
Brooklyn, NY 11219
Phone (718) 850-6433

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244592000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1265668776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 BANNER AVE",
            "address_2": "APT. 10C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355260",
            "telephone_number": "718-853-6433",
            "fax_number": "718-853-6449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 49TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192922",
            "telephone_number": "718-853-6433",
            "fax_number": "718-853-6449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUTTY",
        "first_name": "CHRISTOPHER",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-10",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MA",
            "license": "229422",
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "NY",
            "license": "257416",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NY",
            "license": "257416",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.