Active NPI
Changyong Shin
- Mental Health Clinic/Center (Including Community Mental Health Center)
- New York, NY
National Provider Identifier
1346992419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Practice address
- 7 W 30TH St
New York, NY 10001-4406 - Phone
- (212) 725-7850
- NPI assigned
- Jan 20, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Primary |
Addresses
Primary practice location
7 W 30TH St
New York, NY 10001-4406
Mailing address
41 Conforti Ave
West Orange, NJ 07052-2824
Phone (973) 307-7576
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blanton-Peale Institute | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Counselor
- New York City, NY
- NPI 1225195787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642636800000",
"number": "1346992419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "41 CONFORTI AVE",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070522824",
"telephone_number": "973-307-7576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 W 30TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100014406",
"telephone_number": "212-725-7850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIN",
"first_name": "CHANGYONG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-20",
"last_updated": "2022-01-20",
"certification_date": "2022-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.