DR. TIMOTHY SHIM MD
NPI 1467031112
Student in an Organized Health Care Education/Training Program in Stony Brook, NY

Q: What is Timothy Shim's NPI number?

The NPI number for Timothy Shim is 1467031112. It was assigned to this individual provider in the NPPES registry on April 7, 2021.

Q: What is Timothy Shim's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Timothy Shim was last updated on April 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 07, 2021PECOS Enrolled

101 NICOLLS RD, STONY BROOK, NY 11794(631) 689-8333 Get Directions Write a Review

NPPES record last updated: April 7, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dr. Timothy Shim Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. TIMOTHY SHIM MD (NPI 1467031112) is an individual student in an organized health care education/training program in Stony Brook, New York and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1467031112

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDR. TIMOTHY SHIMCredential: MD

Location Address101 NICOLLS RDStony Brook, NY 11794-0001

Mailing Address9 Miller DrBoonton Township, NJ 07005-9236 · (973) 349-9349

Phone(631) 689-8333

Sole ProprietorNo

Enumeration DateApril 7, 2021

NPPES CertifiedApril 7, 2021

✔ NPI 1467031112 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

101 NICOLLS RD, Stony Brook, NY 11794

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Timothy Shim Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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