Provider Demographics
NPI:1124090329
Name:SHIN, IN SOOK J (MD)
Entity type:Individual
Prefix:
First Name:IN SOOK
Middle Name:J
Last Name:SHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7 COMMUNITY DRIVE
Mailing Address - Street 2:ASPIRE OF WNY, INC.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2523
Mailing Address - Country:US
Mailing Address - Phone:716-505-5634
Mailing Address - Fax:716-892-1936
Practice Address - Street 1:7 COMMUNITY DRIVE
Practice Address - Street 2:ASPIRE OF WNY, INC.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-2523
Practice Address - Country:US
Practice Address - Phone:716-505-5634
Practice Address - Fax:716-892-1936
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY134927-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474924Medicaid
NY00651592Medicare ID - Type Unspecified
NY11472PMedicare UPIN
NYD74834Medicare UPIN
NY00474924Medicaid