Healthcare Provider Details

I. General information

NPI: 1326080342
Provider Name (Legal Business Name): RICHARD GARY SHINBROT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STUART GATE OFFICE B
NORTH MASSAPEQUA NY
11758-2456
US

IV. Provider business mailing address

1 STUART GATE OFFICE B
NORTH MASSAPEQUA NY
11758-2456
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:
Title or Position:
Credential:
Phone: