Provider Demographics
NPI:1265417299
Name:SHIM, JAN J (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:J
Last Name:SHIM
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 1:4 E 88TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0509
Mailing Address - Country:US
Mailing Address - Phone:212-535-5020
Mailing Address - Fax:212-535-6494
Practice Address - Street 1:4 EAST 88TH STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-535-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191275207RG0100X
NJ25MA06650200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF86603Medicare UPIN
NY2V9271Medicare ID - Type Unspecified
NJF86603Medicare UPIN