Provider Demographics
NPI:1447293865
Name:SCHULMAN, IRENE AUDREY (MD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:AUDREY
Last Name:SCHULMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAUPPAUGE RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4403
Mailing Address - Country:US
Mailing Address - Phone:631-499-2642
Mailing Address - Fax:631-588-4595
Practice Address - Street 1:4355 147TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-1736
Practice Address - Country:US
Practice Address - Phone:718-762-0900
Practice Address - Fax:718-886-5659
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167342174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01669061Medicaid
NY11355502OtherCAQH
NYG14143Medicare UPIN
NY01669061Medicaid