Provider Demographics
NPI:1285640730
Name:SHIM, JOSEPH Y (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:Y
Last Name:SHIM
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 1:5650 FRANCIS LEWIS BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1635
Mailing Address - Country:US
Mailing Address - Phone:718-279-8107
Mailing Address - Fax:718-279-8101
Practice Address - Street 1:5650 FRANCIS LEWIS BLVD FL 1
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1635
Practice Address - Country:US
Practice Address - Phone:718-279-8107
Practice Address - Fax:718-279-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213823174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113508930OtherTAX ID
NYP1895653OtherOXFORD
NY02153428Medicaid
NY2325482OtherAETNA
NY196315AOtherMAGNACARE
NY831931OtherBLUE CROSS BLUE SHIELDS
NY2325482OtherAETNA
NYH02727Medicare UPIN