Jae Yoon Shin DPM P.C.
Organization Active NPI Podiatric Clinic/Center · Paramus, NJ
NPI 1760135636 · NPPES record last updated Feb 1, 2022
Key facts
- NPI
- 1760135636
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatric Clinic/Center 261QP1100X
- Legal business name
- JAE YOON SHIN DPM P.C.
- Practice address
- 283 Leonard PL
Paramus, NJ 07652-4517 - Phone
- (267) 269-7127
- NPI assigned
- Feb 1, 2022
- Organization subpart
- No
Authorized official
- Name
- Jae Yoon Shin, DPM
- Title
- Owner
- Phone
- (267) 269-7127
Practitioners 1
-
Jae Yoon Shin, D.P.M.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220215002715 | NJ | Part B Supplier - Clinic/Group Practice | 3274926241 |
Receives reassigned benefits from 1 practitioner Practice locations: Paramus, NJ |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatric Clinic/Center | 261QP1100X | Yes |
Addresses
Primary practice location
283 Leonard PL
Paramus, NJ 07652-4517
Mailing address
4220 27TH St Apt 515
Long Island City, NY 11101-8618
Phone (267) 268-7127
Other practice location 1
17 Brinkerhoff Ter # 202
Palisades Park, NJ 07650-1101
Phone (267) 269-7127
Other practice location 2
4220 27th St Apt 515
Long Island City, NY 11101-8618
Phone (267) 268-7127
Other practice location 3
620 Cranbury Rd Ste 106
East Brunswick, NJ 08816-4000
Phone (267) 269-7127
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| POD001311 | Other | GA | PODIATRIC LICENSE |
| 25MD00365800 | Other | NJ | PODIATRIC LICENSE |
| N007210-01 | Other | NY | PODIATRIC LICENSE |
Other providers in Paramus, NJ
- Bethsy Jacob
- Deepa Jacob
- Tony Jacob
- Stephen Howard Jacobs
- Adina Kwestel Jacobson
- Zahra Batool Jafary
- Summer Jaffrey
- Carolyn F Jaime
- Jandee Anesthesiology
- Janice Jang
All providers in Paramus, NJ · Podiatric Clinic/Center in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.