Healthcare Provider Details

I. General information

NPI: 1376926709
Provider Name (Legal Business Name): ALEX SHIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 LAFAYETTE RD STE 202
SPARTA NJ
07871-3560
US

IV. Provider business mailing address

376 LAFAYETTE RD STE 202
SPARTA NJ
07871-3560
US

V. Phone/Fax

Practice location:
  • Phone: 908-684-3005
  • Fax: 908-684-3302
Mailing address:
  • Phone: 908-684-2480
  • Fax: 877-737-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MB10998000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOT016307
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: