Provider Demographics
NPI:1093882722
Name:GINZBERG, JONATHAN N (LIC AC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:N
Last Name:GINZBERG
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:CUMMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01026-0300
Mailing Address - Country:US
Mailing Address - Phone:413-634-5575
Mailing Address - Fax:
Practice Address - Street 1:11 SWIFT RIVER RD
Practice Address - Street 2:
Practice Address - City:CUMMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01026-9731
Practice Address - Country:US
Practice Address - Phone:413-634-5575
Practice Address - Fax:413-200-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist