Jack Shamoun

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

107225 Issued in NY

Practice address

CRHP-711 Troy-Schenectady Road
Suite 114
Latham, NY 12110

Phone

(518) 786-1600

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Albany Medical Center Hospital

  • General Acute Care Hospital
  • Albany, NY
  • NPI 1811917461
  NPD (past)
• Albany Medical Center South Clinical Campus

  • Diagnostic Ultrasound Physician
  • Albany, NY
  • NPI 1669408332

  Diagnostic Radiology

  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197072000000",
    "number": "1508940354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 TROY SCHENECTADY RD",
            "address_2": "SUITE 201",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CRHP-711 TROY-SCHENECTADY ROAD",
            "address_2": "SUITE 114",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "12110",
            "telephone_number": "518-786-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAMOUN",
        "first_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine",
            "state": "NY",
            "license": "107225",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "107225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00369466",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michaela Serselouodi, DDS
• Seton Health System
• Samit N Shah, MD
• Shaker Pediatrics PC
• Shalom Kieval MD PC
• Peter Johnston Shaughnessy, MD
• Deborah Margaret Shea, PTA
• Rebecca Rose Sheehan, PNP
• Aysha Imran Sheikh
• Lisa Sheldon, OD

• Diagnostic Radiology Physician in Latham, NY
• Providers in Latham, NY by specialty
• Diagnostic Radiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2007; 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.