Randolph Scott Shipon, PH.D., NCC, LPC

Primary specialty

PsychologistTaxonomy code 103T00000X

License

35SI00473800 Issued in NJ

Practice address

550 W Main St
Boonton, NJ 07005-1168

Phone

(215) 906-3967

Fax

(973) 300-1443

NPI assigned

Apr 20, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Dr. Wolf Shipon Other name

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263945600000",
    "number": "1679716781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 DEER HILL CT",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051861",
            "telephone_number": "215-906-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W MAIN ST",
            "city": "BOONTON",
            "state": "NJ",
            "postal_code": "070051168",
            "telephone_number": "215-906-3967",
            "fax_number": "973-300-1443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIPON",
        "first_name": "RANDOLPH",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "PH.D., NCC, LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-20",
        "last_updated": "2010-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35SI00473800",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "018363",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "DE",
            "license": "B1-0000832",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WOLF",
            "last_name": "SHIPON",
            "prefix": "DR.",
            "credential": "PH.D., NCC, LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Patrick M Selimo, DC
• Samuel P Selimo, DC
• Anisha Sharma
• Pankil Rajendra Sheth, DOCTOR OF PHARMACY
• Maggie Shin
• Rushank Shukla, RPH
• Michelle Therese Simmers, OTR/L
• Sarabjit Singh, MD
• Lynn Nicole Skrzat, PT, DPT
• Kathryn Smilowitz

• Psychologist in Boonton, NJ
• Providers in Boonton, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.