Basic Information
| Provider Information | |||||||||
| NPI: | 1073562195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIMELMAN | ||||||||
| FirstName: | MYER | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHIMELMAN | ||||||||
| OtherFirstName: | M | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036245522 | ||||||||
| FaxNumber: | 2036244301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LONG WHARF DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065115991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036245522 | ||||||||
| FaxNumber: | 2036244301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 01/09/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 0015578 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 004082286 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | NHS125 | 01 | OXFORD | OTHER | 008042339 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 004082260 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 008024427 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 001155787 | 01 | CT | MEDICAID DR. SHIMELMAN'S INDIVIDUAL # | OTHER | 004041000 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 008022622 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 010015578CT01 | 01 | CT | ANTHEM BLUE CROSS BLUE SH | OTHER | 1548465321 | 01 | CT | GROUP NPI | OTHER | 168637 | 01 | MANAGED HEALTH NETWORK | OTHER | 500000315 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 008001325 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 008022626 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 008023170 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 004217099 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 2238345 | 01 | CIGNA BEHAVIORAL HEALTH G | OTHER | 008003745 | 01 | CT | MEDICAID APT FOUNDATION INC. | OTHER | 329219 | 01 | MAGELLAN BEHAVIORAL HEALT | OTHER | 0015578 | 01 | CIGNA BEHAVIORAL HEALTH | OTHER | 164472 | 01 | VALUE OPTIONS | OTHER | C01033 | 01 | CT | MEDICARE APT FOUNDATION INC. | OTHER |