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General NPI Number Information
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NPI Number | 1659334498
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Entity Type | Individual
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Provider Name | MIRA SHIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 2050 CENTER AVE STE 425
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City | FORT LEE
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State | NJ
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Zip | 07024-4911
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Country | US
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Telephone | 201-261-1000
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Fax | 201-261-1188
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Provider Business Mailing Address
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Address Line | 2050 CENTER AVE STE 425
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City | FORT LEE
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State | NJ
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Zip | 07024-4911
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Country | US
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Telephone | 201-261-1000
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Fax | 201-261-1188
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA07929700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 25MA07929700
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MA07929700
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MA07929700
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 25MA07929700
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | 25MA07929700
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License Number State | NJ
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