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Contact Information

JACK SHAMOUN
CRHP-711 TROY-SCHENECTADY ROAD
SUITE 114
LATHAM, NY12110
 Phone: 518-786-1600
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Nuclear Medicine

207U00000X 36 Physician/Nuclear Medicine
Indicates primary specialty

NPI Profile & details for JACK SHAMOUN · (Male)

NPI # 1508940354
Status Active
Credentials
Entity Individual
Enumeration date 10/25/2006
Last updated 12/08/2007 - About 19 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 107225
  • NY Medicaid 00369466
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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