Healthcare Provider Details

I. General information

NPI: 1205937091
Provider Name (Legal Business Name): RICHARD G. SHINBROT, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE STUART GATE OFFICE B
NORTH MASSAPEQUA NY
11758
US

IV. Provider business mailing address

ONE STUART GATE OFFICE B
NORTH MASSAPEQUA NY
11758
US

V. Phone/Fax

Practice location:
  • Phone: 516-795-1100
  • Fax: 516-795-9439
Mailing address:
  • Phone: 516-795-1100
  • Fax: 516-795-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number182215
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD GARY SHINBROT
Title or Position: PRESIDENT
Credential: DO
Phone: 516-795-1100