Camp Shane

Primary specialty

CounselorTaxonomy code 101Y00000X

License

R049213-1 Issued in NY

Legal business name

CAMP SHANE

Practice address

134 Teatown Rd
Croton on Hudson, NY 10520-3524

Phone

(626) 797-9977

NPI assigned

May 3, 2012

Organization subpart

Yes

Parent organization

SHANE FITAs reported in NPPES

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

Authorized official

Name

David Ettenberg, M.D.

Title

Owner

Phone

(626) 797-9977

Specialties & licenses 1

Addresses

Part of

Shane Fit

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

{
    "created_epoch": "1336003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1356600845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 TEATOWN RD",
            "city": "CROTON ON HUDSON",
            "state": "NY",
            "postal_code": "105203524",
            "telephone_number": "626-797-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 TEATOWN RD",
            "city": "CROTON ON HUDSON",
            "state": "NY",
            "postal_code": "105203524",
            "telephone_number": "626-797-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMP SHANE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHANE FIT",
        "enumeration_date": "2012-05-03",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "ETTENBERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-797-9977",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": "NY",
            "license": "R049213-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raegan Briar, DPT
• Brittany Broughal, LMFT
• Kayon L Brown, MSED
• Laura Burnett
• Marianne Calo, R.N.
• Christopher John Campo, P.T., D.P.T.
• Lauren Renee Carroll, M.S CCC-SLP
• Amanda Josephine Casey, LMSW
• Samantha Catalano, IBCLC
• Amanda Cavalieri

• Counselor in Croton on Hudson, NY
• Providers in Croton on Hudson, NY by specialty
• Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.