MEDICARE: DR. SUSAN C SHIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	255377	NY
2	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	25MA11140600	NJ
3	2084N0400X	Neurology Physician	25MA11140600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	255377	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1871790105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN C SHIN M.D.

Provider Business Mailing Address
First Line	:	1468 MADISON AVE
Second Line	:	ANNENBERG 2ND FLOOR, PO BOX 1052
City	:	NEW YORK
State	:	NY
Zip	:	10029-6508
Country	:	US
Telephone Number	:	212-241-1639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 MADISON AVE
Second Line	:	ANNENBERG 2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10029-6508
Country	:	US
Telephone Number	:	212-241-1639
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	01/21/2026

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