Provider Demographics
NPI:1417055468
Name:SHIPLEY, NEAL MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:MICHAEL
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NEAL
Other - Middle Name:MICHAEL
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:136 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6604
Mailing Address - Country:US
Mailing Address - Phone:212-866-3366
Mailing Address - Fax:
Practice Address - Street 1:199 AMSTERDAM AVENUE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-721-4200
Practice Address - Fax:212-721-4201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07698900207P00000X
NY175842207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181421Medicaid
F64886Medicare UPIN
NJ0181421Medicaid
NJ080917Medicare PIN