Individual provider Active NPI

Norman Howard Shulder, LCSW-R

  • Social Worker
  • Holtsville, NY
National Provider Identifier
1376618728
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
R0353541 Issued in NY
Practice address
755 Waverly Avenue Suite 304
Holtsville, NY 11742
Phone
(631) 447-9600
Fax
(631) 447-0511
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X R0353541 NY Primary

Addresses

Primary practice location

755 Waverly Avenue Suite 304
Holtsville, NY 11742

Mailing address

11 Russell Lane
Patchogue, NY 11772-0446
Phone (631) 654-9279

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171116001003 NY Practitioner - Clinical Social Worker 1254697725 Practice locations: Holtsville, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1150 Portion Rd
Suite 18
Holtsville, NY 11742-1074
Phone (631) 447-9600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R0353541NYMDSocial Worker

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376618728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 RUSSELL LANE",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117720446",
            "telephone_number": "631-654-9279",
            "fax_number": "631-447-0511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 WAVERLY AVENUE SUITE 304",
            "city": "HOLTSVILLE",
            "state": "NY",
            "postal_code": "11742",
            "telephone_number": "631-447-9600",
            "fax_number": "631-447-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHULDER",
        "first_name": "NORMAN",
        "middle_name": "HOWARD",
        "name_prefix": "Mr.",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "R0353541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holtsville, NY

Sources for this page

Verify at the official NPI Registry.