Basic Information
| Provider Information | |||||||||
| NPI: | 1548465321 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | M.B. SHIMELMAN, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 LONG WHARF DRIVE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036245522 | ||||||||
| FaxNumber: | 2036244301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 LONG WHARF DRIVE | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036245522 | ||||||||
| FaxNumber: | 2036244301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHIMELMAN | ||||||||
| AuthorizedOfficialFirstName: | MYER | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2036245522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CT | N | Agencies | Community/Behavioral Health | 2084P0800X | 015578 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.