Provider Demographics
NPI:1093701971
Name:SHORIN, ROBERT N (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:N
Last Name:SHORIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0080
Mailing Address - Country:US
Mailing Address - Phone:516-314-1766
Mailing Address - Fax:516-364-1318
Practice Address - Street 1:30 WYNN COURT
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2426
Practice Address - Country:US
Practice Address - Phone:516-314-1766
Practice Address - Fax:516-364-1318
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0217221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY140021722NY01OtherANTHEM
NY056446OtherVALUE OPTIONS
NY7403193OtherGHI
NY140021722NY01OtherANTHEM