1073562195 NPI number — DR. MYER B SHIMELMAN MD

Table of content: DR. MYER B SHIMELMAN MD (NPI 1073562195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073562195 NPI number — DR. MYER B SHIMELMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIMELMAN
Provider First Name:
MYER
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHIMELMAN
Provider Other First Name:
M
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073562195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 LONG WHARF DR
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-624-5522
Provider Business Mailing Address Fax Number:
203-624-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 LONG WHARF DR
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511-5991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-624-5522
Provider Business Practice Location Address Fax Number:
203-624-4301
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0015578 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004082286 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NHS125 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008042339 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004082260 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008024427 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001155787 . This is a "MEDICAID DR. SHIMELMAN'S INDIVIDUAL #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004041000 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008022622 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010015578CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1548465321 . This is a "GROUP NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 168637 . This is a "MANAGED HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500000315 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008001325 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008022626 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 008023170 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 004217099 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2238345 . This is a "CIGNA BEHAVIORAL HEALTH G" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008003745 . This is a "MEDICAID APT FOUNDATION INC." identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 329219 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0015578 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".




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