1659334498 NPI number — DR. MIRA SHIN M.D.

Table of content: DR. MIRA SHIN M.D. (NPI 1659334498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659334498 NPI number — DR. MIRA SHIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIN
Provider First Name:
MIRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659334498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 CENTER AVE
Provider Second Line Business Mailing Address:
STE 425
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-4911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-261-1000
Provider Business Mailing Address Fax Number:
201-261-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 CENTER AVE
Provider Second Line Business Practice Location Address:
STE 425
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-4911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-261-1000
Provider Business Practice Location Address Fax Number:
201-261-1188
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA07929700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 25MA07929700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081H0002X , with the licence number: 25MA07929700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 25MA07929700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081S0010X , with the licence number: 25MA07929700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083S0010X , with the licence number: 25MA07929700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9404330 . This is a "PHCS (PRIVATE HEALTHCARE SYSTEMS)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20-8831104 . This is a "TAX ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20-8831104 . This is a "MULTIPLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7687754 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3635893 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20-8831104 . This is a "FAMILY CHOICE HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K6327 . This is a "HEALTHNET (PHS)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 161568 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 20-8831104 . This is a "CONSUMER HEALTH NETWORK(CHN)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3696X1 . This is a "EMPIRE BLUECROSSBLUESHIELD NY (WELL CHOICE)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1151716 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1749400 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K2116 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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