New Jersey Physical Medicine & Rehabilitation Institute PA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

25MA07929700 Issued in NJ

Legal business name

NEW JERSEY PHYSICAL MEDICINE & REHABILITATION INSTITUTE PA

Practice address

2050 Center Ave
Ste 425
Fort Lee, NJ 07024-4911

Phone

(201) 261-1000

Fax

(201) 261-1188

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mira Shin, M.D.NPI 1659334498

Title

Ceo

Phone

(201) 261-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mira Shin, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Fort Lee, NJ
  • NPI 1659334498
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454630400000",
    "number": "1821210261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 CENTER AVE",
            "address_2": "STE 425",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070244911",
            "telephone_number": "201-261-1000",
            "fax_number": "201-261-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 CENTER AVE",
            "address_2": "STE 425",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070244911",
            "telephone_number": "201-261-1000",
            "fax_number": "201-261-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW JERSEY PHYSICAL MEDICINE & REHABILITATION INSTITUTE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2016-02-05",
        "status": "A",
        "authorized_official_last_name": "SHIN",
        "authorized_official_first_name": "MIRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "201-261-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NJ",
            "license": "25MA07929700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR MIRA SHIN, M.D.",
            "identifier": "1659334498",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Physical Medicine & Rehabilitation Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.