| The Shield Institute | |
|
3909 214th Pl Bayside NY 11361-2123 | |
| (718) 269-2004 | |
| Not Available |
| Full Name | The Shield Institute |
|---|---|
| Speciality | Clinic/Center |
| Location | 3909 214th Pl, Bayside, New York |
| Authorized Official Name and Position | Susan Provenzano (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7188861682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Shield Institute 144-61 Roosevelt Avenue Flushing NY 11354 Ph: () - | The Shield Institute 3909 214th Pl Bayside NY 11361-2123 Ph: (718) 269-2004 |
| NPI Number | 1184661290 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 04/24/2018 |
| Medicare PECOS PAC ID | 2264472026 |
|---|---|
| Medicare Enrollment ID | O20050511000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184661290 | NPI | - | NPPES |
| 00243949 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 6593164 (New York) | Primary |
| Provider Name | Karyn R Price |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548477847 PECOS PAC ID: 2769388735 Enrollment ID: I20031210000506 |
| Provider Name | Roberta L Donin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003832627 PECOS PAC ID: 3870574155 Enrollment ID: I20040525000513 |
| Provider Name | Richard Zelhof |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497724637 PECOS PAC ID: 0244293678 Enrollment ID: I20041108000311 |
| Provider Name | Jeannette Mangiere |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437370343 PECOS PAC ID: 7315988276 Enrollment ID: I20050520000456 |
| Provider Name | Giulia Fagan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083835938 PECOS PAC ID: 9638110596 Enrollment ID: I20050809000176 |
| Provider Name | Sylvia A Bottarini |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851333264 PECOS PAC ID: 5698700425 Enrollment ID: I20050930000040 |
| Provider Name | Amy Muskin Galan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710042288 PECOS PAC ID: 5799791240 Enrollment ID: I20060221000887 |
| Provider Name | Michael E Kaufer |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1700942067 PECOS PAC ID: 8921168022 Enrollment ID: I20091014000296 |
| Provider Name | John M John |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023291952 PECOS PAC ID: 5890830996 Enrollment ID: I20100301000344 |
| Provider Name | Rebecca L Walsh |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1598074023 PECOS PAC ID: 8729246434 Enrollment ID: I20120228000093 |
| Provider Name | Robyn B Landau |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1457483737 PECOS PAC ID: 9638337264 Enrollment ID: I20120228000345 |
| Provider Name | Luanne Horne |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972874642 PECOS PAC ID: 3375702566 Enrollment ID: I20120307000711 |
| Provider Name | Dana M Starr-grave |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1942515580 PECOS PAC ID: 4284889502 Enrollment ID: I20130312000246 |
| Provider Name | Peter V Senatore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578937058 PECOS PAC ID: 5496051708 Enrollment ID: I20160314000809 |
| Provider Name | Sylvene T Blissett |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1821207341 PECOS PAC ID: 3375832215 Enrollment ID: I20160517001876 |
| Provider Name | Ahmed A Abdeldayem |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568860104 PECOS PAC ID: 4183914625 Enrollment ID: I20160613000282 |
| Provider Name | Mentwab Wuhib |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982065728 PECOS PAC ID: 8628364270 Enrollment ID: I20160907001706 |
| Provider Name | Andie L Felsberg |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1184071417 PECOS PAC ID: 1557624335 Enrollment ID: I20180409000833 |
| Provider Name | Jamie L Bernstein |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477069128 PECOS PAC ID: 2769747443 Enrollment ID: I20180530001225 |
| Provider Name | Ahmad Abdalmonum |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1528599636 PECOS PAC ID: 2769721521 Enrollment ID: I20190222001410 |
| Provider Name | Jennifer Robertson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1831412949 PECOS PAC ID: 8426380585 Enrollment ID: I20191023001367 |
| Provider Name | Deborah E Witthauer |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1710599709 PECOS PAC ID: 4587036546 Enrollment ID: I20230221001335 |
| Provider Name | Cheryl M Henderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518747864 PECOS PAC ID: 5294182853 Enrollment ID: I20231103002565 |
| Provider Name | Sade S Porter |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710626221 PECOS PAC ID: 3375994528 Enrollment ID: I20240111003618 |
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