Healthcare Provider Details

I. General information

NPI: 1811942782
Provider Name (Legal Business Name): SHINE MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 AUSTIN ST
FOREST HILLS NY
11375-4220
US

IV. Provider business mailing address

6860 AUSTIN ST
FOREST HILLS NY
11375-4224
US

V. Phone/Fax

Practice location:
  • Phone: 718-896-0999
  • Fax: 718-896-8502
Mailing address:
  • Phone: 718-896-0999
  • Fax: 718-896-8502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SERGEY GABINSKY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 718-896-0999