Healthcare Provider Details

I. General information

NPI: 1548465321
Provider Name (Legal Business Name): M.B. SHIMELMAN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DRIVE SUITE 212
NEW HAVEN CT
06511
US

IV. Provider business mailing address

1 LONG WHARF DRIVE SUITE 212
NEW HAVEN CT
06511
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-5522
  • Fax: 203-624-4301
Mailing address:
  • Phone: 203-624-5522
  • Fax: 203-624-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number015578
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCT

VIII. Authorized Official

Name: MYER B SHIMELMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 203-624-5522