Provider Demographics
NPI:1750476644
Name:SHINE, DANIEL ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ISAAC
Last Name:SHINE
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:NEW YORK UNIVERSITY HOSPITALS CENTER 555 FIRST AVE.
Mailing Address - Street 2:TISCH 1626
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6497
Mailing Address - Country:US
Mailing Address - Phone:212-263-3250
Mailing Address - Fax:212-263-3882
Practice Address - Street 1:NEW YORK UNIVERSITY HOSPITALS CENTER 555 FIRST AVE.
Practice Address - Street 2:TISCH 1626
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6497
Practice Address - Country:US
Practice Address - Phone:212-263-3250
Practice Address - Fax:212-263-3882
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ23D041Medicaid
NJ23D041Medicaid