Provider Demographics
NPI:1275842452
Name:SHIMELFARB, MARIANNA B (MD)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:B
Last Name:SHIMELFARB
Suffix:
Gender:F
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:PO BOX 95000-2454
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2454
Mailing Address - Country:US
Mailing Address - Phone:718-218-0450
Mailing Address - Fax:
Practice Address - Street 1:48-50 FAIRFIELD STREET
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-744-8511
Practice Address - Fax:973-744-6356
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09722100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine