Provider Demographics
NPI:1467560763
Name:SHOBIN, DAVID MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:SHOBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 RT 11
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4732
Mailing Address - Country:US
Mailing Address - Phone:631-724-6224
Mailing Address - Fax:631-724-6282
Practice Address - Street 1:498 RT 11
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4732
Practice Address - Country:US
Practice Address - Phone:631-724-6224
Practice Address - Fax:631-724-6282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10611207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00708416Medicaid
160044780Medicare ID - Type Unspecified
NY00708416Medicaid