Seung J. Park Shin, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

A123206-1 Issued in NY

Practice address

450 Clarkson Ave
MSC 80
Brooklyn, NY 11203

Phone

(718) 613-8481

Fax

(718) 613-8498

NPI assigned

Dec 2, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: seungpark@sunydmc.allscriptsdirect.net

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.

• University Physicians of Brooklyn, Inc.

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1366506271
  Medicare reassignment NPD
• University Hospital of Brooklyn Suny Downstate Health Sciences Univers

  • Rehabilitation Hospital Unit
  • Brooklyn, NY
  • NPI 1285693275
  NPD (past)
• University Physicians of Brooklyn, Inc

  • Anesthesiology Physician
  • Brooklyn, NY
  • NPI 1104878180
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1497739452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "address_2": "MSC 80",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032056",
            "telephone_number": "718-613-8481",
            "fax_number": "718-613-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "address_2": "MSC 80",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-613-8481",
            "fax_number": "718-613-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK SHIN",
        "first_name": "SEUNG",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-02",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NY",
            "license": "A123206-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00231618",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Park Optics LLC
• Park Physical Therapy PLLC
• Park Place Pharmacy, Inc
• Park RX Inc
• Park RX Inc
• Park Slope 360 Medical PC
• Park Slope Acupuncture PLLC
• Park Slope Advanced Medical, PLLC
• Park Slope Anesthesia Associates PC
• Park Slope Cardiology PC

• Physical Medicine & Rehabilitation Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Physical Medicine & Rehabilitation Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.