Provider Demographics
NPI:1952660318
Name:WILLIAM SHIN PEDIATRIC PC
Entity Type:Organization
Organization Name:WILLIAM SHIN PEDIATRIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-463-0101
Mailing Address - Street 1:4221 162ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4126
Mailing Address - Country:US
Mailing Address - Phone:718-463-0101
Mailing Address - Fax:917-563-5321
Practice Address - Street 1:4221 162ND ST
Practice Address - Street 2:#1FL.
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4126
Practice Address - Country:US
Practice Address - Phone:718-463-0101
Practice Address - Fax:917-563-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02203249Medicaid