Individual
DR. MIRA SHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2050 CENTER AVE, STE 425, FORT LEE, NJ 07024-4911
(201) 261-1000
(201) 261-1188
Mailing address
2050 CENTER AVE, STE 425, FORT LEE, NJ 07024-4911
(201) 261-1000
(201) 261-1188
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA07929700
NJ
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25MA07929700
NJ
2081H0002X
Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
25MA07929700
NJ
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
25MA07929700
NJ
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
25MA07929700
NJ
2083S0010X
Sports Medicine (Preventive Medicine) Physician
25MA07929700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1151716
AETNA HMO #
NJ
01
—
161568
GHI
NJ
01
—
1749400
CIGNA
NJ
01
—
20-8831104
TAX ID #
NJ
01
—
3696X1
EMPIRE BLUECROSSBLUESHIELD NY (WELL CHOICE)
NY
01
—
3K2116
HEALTHNET #
NJ
01
—
3K6327
HEALTHNET (PHS)
NJ
01
—
7687754
AETNA PPO #
NJ
01
—
9404330
PHCS (PRIVATE HEALTHCARE SYSTEMS)
NJ
01
—
P3635893
OXFORD #
NJ
Enumeration date
04/11/2006
Last updated
02/05/2016
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