Healthcare Provider Details

I. General information

NPI: 1245178342
Provider Name (Legal Business Name): YONATHAN SHIMRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SUMMIT AVE
HACKENSACK NJ
07601-8503
US

IV. Provider business mailing address

107 PAULIN BLVD
LEONIA NJ
07605-1221
US

V. Phone/Fax

Practice location:
  • Phone: 201-658-3065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15609700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: