Provider Demographics
NPI:1235259862
Name:NIHON SHIKA GROUP
Entity Type:Organization
Organization Name:NIHON SHIKA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELOK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MPH
Authorized Official - Phone:201-461-0618
Mailing Address - Street 1:1212 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1431
Mailing Address - Country:US
Mailing Address - Phone:203-637-1115
Mailing Address - Fax:
Practice Address - Street 1:1212 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1431
Practice Address - Country:US
Practice Address - Phone:203-637-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4494261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental