MEDICARE: KENT D SHINBACH MD PC

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
1	173000000X	Legal Medicine	UY95859	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1578521456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENT D SHINBACH MD PC

Provider Business Mailing Address
First Line	:	435 E 79TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-1034
Country	:	US
Telephone Number	:	212-744-7102
Fax Number	:	212-794-8906

Provider Business Practice Location Address
First Line	:	435 E 79TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-1034
Country	:	US
Telephone Number	:	212-744-7102
Fax Number	:	212-794-9726

Authorized Official
Title or Position	:	DIRECTOR OFFICER
Name	:	DR. KENT SHINBACH
Credential	:
Telephone Number	:	212-744-7100

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	06/24/2008

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