Provider Demographics
NPI:1033472568
Name:NOTIK, SHIMRAT R (MD)
Entity Type:Individual
Prefix:
First Name:SHIMRAT
Middle Name:R
Last Name:NOTIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIMRAT
Other - Middle Name:R
Other - Last Name:YANIV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:999 SUMMER ST
Mailing Address - Street 2:STE 305
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5513
Mailing Address - Country:US
Mailing Address - Phone:203-428-4440
Mailing Address - Fax:203-890-9449
Practice Address - Street 1:999 SUMMER ST
Practice Address - Street 2:STE 305
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5513
Practice Address - Country:US
Practice Address - Phone:203-428-4440
Practice Address - Fax:203-890-9449
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55533207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology