Healthcare Provider Details

I. General information

NPI: 1912562232
Provider Name (Legal Business Name): CYNTHIA SHIM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 15245
APO AP
96271-5245
US

IV. Provider business mailing address

29 E 29TH ST
BAYONNE NJ
07002-4654
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-1147
  • Fax:
Mailing address:
  • Phone: 201-858-6594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MB11293200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMTL-2024-032
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number315169-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: