Active NPI
Jessica Shimberg, PH.D.
- Clinical Psychologist
- New York, NY
National Provider Identifier
1801146907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 019696
- Practice address
- 80 5TH Ave
Suite 1405
New York, NY 10011-8002 - Phone
- (347) 620-4137
- NPI assigned
- Sep 16, 2012
- Last updated
- Aug 1, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 019696 | NY | Primary |
Addresses
Primary practice location
80 5TH Ave
Suite 1405
New York, NY 10011-8002
Mailing address
80 5TH Ave
Suite 1405
New York, NY 10011-8002
Phone (347) 620-4137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 13, 2022 through Jan 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470009600000",
"number": "1801146907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 5TH AVE",
"address_2": "SUITE 1405",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100118002",
"telephone_number": "347-620-4137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 5TH AVE",
"address_2": "SUITE 1405",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100118002",
"telephone_number": "347-620-4137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIMBERG",
"first_name": "JESSICA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-16",
"last_updated": "2016-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.