Provider Demographics
NPI:1164884219
Name:SHIMANOVSKY, ANTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:SHIMANOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 LONG RIDGE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-323-4458
Mailing Address - Fax:203-352-4663
Practice Address - Street 1:292 LONG RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-323-4458
Practice Address - Fax:203-352-4663
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64112207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine