Healthcare Provider Details

I. General information

NPI: 1578521456
Provider Name (Legal Business Name): KENT D SHINBACH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E 79TH ST
NEW YORK NY
10021-1034
US

IV. Provider business mailing address

435 E 79TH ST
NEW YORK NY
10021-1034
US

V. Phone/Fax

Practice location:
  • Phone: 212-744-7102
  • Fax: 212-794-9726
Mailing address:
  • Phone: 212-744-7102
  • Fax: 212-794-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberUY95859
License Number StateNY

VIII. Authorized Official

Name: DR. KENT SHINBACH
Title or Position: DIRECTOR OFFICER
Credential:
Phone: 212-744-7100