Healthcare Provider Details

I. General information

NPI: 1992762793
Provider Name (Legal Business Name): KENT SHINBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KENT SHINBACH M.D.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E 75TH ST 1A
NEW YORK NY
10021-2625
US

IV. Provider business mailing address

14 E 75TH ST 1A
NEW YORK NY
10021-2625
US

V. Phone/Fax

Practice location:
  • Phone: 212-744-7100
  • Fax: 212-794-9726
Mailing address:
  • Phone: 212-744-7100
  • Fax: 212-794-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number095856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: