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NPI Code Detail

MEDICARE: JUSTINE Y. SHIN

MEDICARE: JUSTINE Y. SHIN
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
1363A00000XPhysician AssistantCT

General Provider Information

NPI Number : 1629721931
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTINE Y. SHIN
Provider Business Mailing Address
First Line : 75 STERLING BLVD APT 308
Second Line :
City : ENGLEWOOD
State : NJ
Zip : 07631-4839
Country : US
Telephone Number : 201-421-8731
Fax Number :
Provider Business Practice Location Address
First Line : 50 OLD FIELD POINT RD FL 3
Second Line :
City : GREENWICH
State : CT
Zip : 06830-6157
Country : US
Telephone Number : 203-862-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2022
Last Update Date : 01/27/2022

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