Active NPI
Dongwuk Shin, M.D.
- Internal Medicine Physician
- River Edge, NJ
National Provider Identifier
1083005151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 25MA02974800
- Practice address
- 130 Kinderkamack Rd.
River Edge, NJ 07661 - Phone
- (201) 567-0633
- Fax
- (201) 567-0633
- NPI assigned
- Feb 11, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 25MA02974800 | NJ | Primary |
| Pulmonary Disease Physician | 207RP1001X | 25MA02974800 | NJ |
Addresses
Primary practice location
130 Kinderkamack Rd.
River Edge, NJ 07661
Mailing address
P.O. Box 247
River Edge, NJ 07661
Phone (201) 567-0633
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA02974800 | NJ | MD | Pulmonary Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423612800000",
"number": "1083005151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 247",
"city": "RIVER EDGE",
"state": "NJ",
"postal_code": "07661",
"telephone_number": "201-567-0633",
"fax_number": "201-567-0633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 KINDERKAMACK RD.",
"city": "RIVER EDGE",
"state": "NJ",
"postal_code": "07661",
"telephone_number": "201-567-0633",
"fax_number": "201-567-0633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "DONGWUK",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-11",
"last_updated": "2015-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "25MA02974800",
"primary": true
},
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "NJ",
"license": "25MA02974800",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in River Edge, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.