Provider Demographics
NPI:1992966717
Name:SHIN, JONG T (DO)
Entity type:Individual
Prefix:DR
First Name:JONG
Middle Name:T
Last Name:SHIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:951 HADDONFIELD RD BLDG A13
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2783
Mailing Address - Country:US
Mailing Address - Phone:856-270-6800
Mailing Address - Fax:856-324-5958
Practice Address - Street 1:951 HADDONFIELD RD # 3B
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2783
Practice Address - Country:US
Practice Address - Phone:856-270-6800
Practice Address - Fax:856-324-5958
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013428207Q00000X, 207QS0010X
NJ25MB08427400207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine