Provider Demographics
NPI:1326080342
Name:SHINBROT, RICHARD GARY (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GARY
Last Name:SHINBROT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 STUART GATE
Mailing Address - Street 2:OFFICE B
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2456
Mailing Address - Country:US
Mailing Address - Phone:516-795-1100
Mailing Address - Fax:516-795-9439
Practice Address - Street 1:1 STUART GATE
Practice Address - Street 2:OFFICE B
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2456
Practice Address - Country:US
Practice Address - Phone:516-795-1100
Practice Address - Fax:516-795-9439
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182215208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF26821Medicare UPIN
NY76L061Medicare ID - Type Unspecified