NPIMap

Ying Shim, MD PA

Organization Active NPI Preferred Provider Organization · Jersey City, NJ

NPI 1942524293 · NPPES record last updated Mar 16, 2010

Key facts

NPI
1942524293
Entity type
Organization (NPI type 2)
Primary specialty
Preferred Provider Organization 305R00000X
License
MA25304 (NJ)
Legal business name
YING SHIM, MD PA
Practice address
3363 Kennedy Blvd
Jersey City, NJ 07307-4225
Phone
(201) 659-3003
Fax
(201) 659-3594
NPI assigned
Mar 16, 2010
Organization subpart
No

Authorized official

Name
Dr. John Y Shim, MD NPI 1538236187
Title
President
Phone
(201) 659-3003

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X MA25304 NJ Yes

Addresses

Primary practice location

3363 Kennedy Blvd
Jersey City, NJ 07307-4225

Mailing address

3363 Kennedy Blvd
Jersey City, NJ 07307-4225
Phone (201) 659-3003

Other identifiers

IdentifierTypeStateIssuer
1D2853302MedicaidNJ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 16, 2010.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1942524293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3363 KENNEDY BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073074225",
            "telephone_number": "201-659-3003",
            "fax_number": "201-659-3594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3363 KENNEDY BLVD",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073074225",
            "telephone_number": "201-659-3003",
            "fax_number": "201-659-3594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YING SHIM, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-659-3003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "MA25304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1D2853302",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jersey City, NJ

All providers in Jersey City, NJ · Preferred Provider Organization in New Jersey

Sources for this page

Verify at the official NPI Registry.