Provider Demographics
| NPI: | 1073562195 |
|---|---|
| Name: | SHIMELMAN, MYER B (MD) |
| Entity Type: | Individual |
| Prefix: | DR |
| First Name: | MYER |
| Middle Name: | B |
| Last Name: | SHIMELMAN |
| Suffix: | |
| Gender: | M |
| Credentials: | MD |
| Other - Prefix: | |
| Other - First Name: | M |
| Other - Middle Name: | B |
| Other - Last Name: | SHIMELMAN |
| Other - Suffix: | |
| Other - Last Name Type: | Professional Name |
| Other - Credentials: | MD |
| Mailing Address - Street 1: | 1 LONG WHARF DR |
| Mailing Address - Street 2: | SUITE 302 |
| Mailing Address - City: | NEW HAVEN |
| Mailing Address - State: | CT |
| Mailing Address - Zip Code: | 06511-5991 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 203-624-5522 |
| Mailing Address - Fax: | 203-624-4301 |
| Practice Address - Street 1: | 1 LONG WHARF DR |
| Practice Address - Street 2: | SUITE 302 |
| Practice Address - City: | NEW HAVEN |
| Practice Address - State: | CT |
| Practice Address - Zip Code: | 06511-5991 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 203-624-5522 |
| Practice Address - Fax: | 203-624-4301 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2006-05-08 |
| Last Update Date: | 2017-01-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CT | 0015578 | 2084P0800X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| CT | 004082286 | Other | MEDICAID APT FOUNDATION INC. |
| NHS125 | Other | OXFORD | |
| CT | 008042339 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 004082260 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 008024427 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 001155787 | Other | MEDICAID DR. SHIMELMAN'S INDIVIDUAL # |
| CT | 004041000 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 008022622 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 010015578CT01 | Other | ANTHEM BLUE CROSS BLUE SH |
| CT | 1548465321 | Other | GROUP NPI |
| 168637 | Other | MANAGED HEALTH NETWORK | |
| CT | 500000315 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 008001325 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 008022626 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 008023170 | Other | MEDICAID APT FOUNDATION INC. |
| CT | 004217099 | Other | MEDICAID APT FOUNDATION INC. |
| 2238345 | Other | CIGNA BEHAVIORAL HEALTH G | |
| CT | 008003745 | Other | MEDICAID APT FOUNDATION INC. |
| 329219 | Other | MAGELLAN BEHAVIORAL HEALT | |
| 0015578 | Other | CIGNA BEHAVIORAL HEALTH | |
| 164472 | Other | VALUE OPTIONS | |
| CT | C01033 | Other | MEDICARE APT FOUNDATION INC. |
| CT | C01033 | Other | MEDICARE APT FOUNDATION INC. |
| B83748 | Medicare UPIN | ||
| C02268 | Medicare ID - Type Unspecified | GROUP |
