Provider Demographics
NPI:1689874620
Name:JOHN SHININ, MD.PC
Entity Type:Organization
Organization Name:JOHN SHININ, MD.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:SHININ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-207-4200
Mailing Address - Street 1:33 MEDFORD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1222
Mailing Address - Country:US
Mailing Address - Phone:631-207-4200
Mailing Address - Fax:631-207-4200
Practice Address - Street 1:33 MEDFORD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1222
Practice Address - Country:US
Practice Address - Phone:631-207-4200
Practice Address - Fax:631-207-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335793Medicaid
NYWGB121Medicare PIN
NY02335793Medicaid