Active NPI
Jeffrey K Shornick, MD
- Dermatology Physician
- Lebanon, NH
National Provider Identifier
1023089711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 16806
- Practice address
- 18 Old Etna Rd
DHMC - Dermatology
Lebanon, NH 03766-1937 - Phone
- (603) 650-3100
- NPI assigned
- Jan 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 023320 | CT | |
| Dermatology Physician | 207N00000X | 16806 | NH | Primary |
Addresses
Primary practice location
18 Old Etna Rd
DHMC - Dermatology
Lebanon, NH 03766-1937
Mailing address
18 Old Etna Rd
DHMC - Dermatology
Lebanon, NH 03766-1937
Phone (603) 650-3100
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001233204 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023320 | CT | MD | Dermatology Physician |
| 16806 | NH | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The New London Hospital Association, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Newport Health Center
- Multi-Specialty Clinic/Center
- Newport, NH
- NPI 1770684672
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486512000000",
"number": "1023089711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18 OLD ETNA RD",
"address_2": "DHMC - DERMATOLOGY",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661937",
"telephone_number": "603-650-3100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18 OLD ETNA RD",
"address_2": "DHMC - DERMATOLOGY",
"city": "LEBANON",
"state": "NH",
"postal_code": "037661937",
"telephone_number": "603-650-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHORNICK",
"first_name": "JEFFREY",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-30",
"last_updated": "2017-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CT",
"license": "023320",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "NH",
"license": "16806",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001233204",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.