Provider Demographics
NPI:1992762793
Name:SHINBACH, KENT (MD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:
Last Name:SHINBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENT
Other - Middle Name:
Other - Last Name:SHINBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14 E 75TH ST
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2625
Mailing Address - Country:US
Mailing Address - Phone:212-744-7100
Mailing Address - Fax:212-794-9726
Practice Address - Street 1:14 E 75TH ST
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2625
Practice Address - Country:US
Practice Address - Phone:212-744-7100
Practice Address - Fax:212-794-9726
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095856103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00419287Medicaid
NYD47423Medicare UPIN
NY504771Medicare PIN
NY02982GMedicare PIN