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NPI Code Detail

MEDICARE: IN SOOK J SHIN MD

MEDICARE: IN SOOK J SHIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician134927-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124090329
Entity Type Code : Individual
Provider Name (Legal Business Name) : IN SOOK J SHIN MD
Provider Business Mailing Address
First Line : 7 COMMUNITY DRIVE
Second Line : ASPIRE OF WNY, INC.
City : BUFFALO
State : NY
Zip : 14225-2523
Country : US
Telephone Number : 716-505-5634
Fax Number : 716-892-1936
Provider Business Practice Location Address
First Line : 7 COMMUNITY DRIVE
Second Line : ASPIRE OF WNY, INC.
City : BUFFALO
State : NY
Zip : 14225-2523
Country : US
Telephone Number : 716-505-5634
Fax Number : 716-892-1936
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 04/10/2012

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