MEDICARE: DR. MICHAEL JAY SHIMBERG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	033697	NY

General Provider Information

NPI Number	:	1083988927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAY SHIMBERG D.D.S.

Provider Business Mailing Address
First Line	:	399 CHESTNUT COURT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4944
Country	:	US
Telephone Number	:	914-245-8896
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 CHESTNUT COURT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4944
Country	:	US
Telephone Number	:	914-245-8896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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