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General NPI Number Information
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NPI Number | 1760135636
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Entity Type | Organization
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Legal Business Name | JAE YOON SHIN DPM P.C.
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 283 LEONARD PL
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City | PARAMUS
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State | NJ
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Zip | 07652-4517
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Country | US
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Telephone | 267-269-7127
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Fax |
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Provider Business Mailing Address
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Address Line | 4220 27TH ST APT 515
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-8618
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Country | US
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Telephone | 267-268-7127
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAE YOON SHIN
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Credential | DPM
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Telephone | 267-269-7127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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