Healthcare Provider Details

I. General information

NPI: 1437441987
Provider Name (Legal Business Name): KENNETH HILLEL SHUBIN STEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 POST RD W
WESTPORT CT
06880-4235
US

IV. Provider business mailing address

55 POST RD W FL 2
WESTPORT CT
06880-4235
US

V. Phone/Fax

Practice location:
  • Phone: 917-905-7236
  • Fax: 917-475-4703
Mailing address:
  • Phone: 917-453-1081
  • Fax: 917-475-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number226900
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number69862
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: