Provider Demographics
NPI:1548465321
Name:M.B. SHIMELMAN, MD, PC
Entity type:Organization
Organization Name:M.B. SHIMELMAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHIMELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-624-5522
Mailing Address - Street 1:1 LONG WHARF DRIVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-624-5522
Mailing Address - Fax:203-624-4301
Practice Address - Street 1:1 LONG WHARF DRIVE
Practice Address - Street 2:SUITE 212
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-624-5522
Practice Address - Fax:203-624-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT251S00000X
CT0155782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
260000429Medicare PIN
CT800002518Medicare PIN
P53571Medicare UPIN
CT260000429Medicare PIN
CTB83748Medicare UPIN
CT500000696Medicare PIN
CTP39873Medicare UPIN