Provider Demographics
NPI:1568478485
Name:SHINEMAN, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:SHINEMAN
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 1:241 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2924
Mailing Address - Country:US
Mailing Address - Phone:631-367-5300
Mailing Address - Fax:631-351-4561
Practice Address - Street 1:241 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2924
Practice Address - Country:US
Practice Address - Phone:631-367-5300
Practice Address - Fax:631-351-4561
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130784-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00374896Medicaid
NY2C4861OtherHEALTHNET
NYCP094OtherOXFORD
NY2698165OtherGHI
NY324981OtherBLUE CROSS/ BLUE SHIELD
NY2698165OtherGHI
NYB13030Medicare UPIN