Provider Demographics
NPI:1154407013
Name:DR GREGORY SHIFRIN OBGYN PC
Entity type:Organization
Organization Name:DR GREGORY SHIFRIN OBGYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIFRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-743-0505
Mailing Address - Street 1:1766 E 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-743-0505
Mailing Address - Fax:718-339-0760
Practice Address - Street 1:1766 E 12TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-743-0505
Practice Address - Fax:718-339-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202259207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01647410Medicaid
NYWWP721Medicare PIN