Provider Demographics
NPI:1386850220
Name:WINICK, JESSE NMI (BS,DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:NMI
Last Name:WINICK
Suffix:
Gender:M
Credentials:BS,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ROCKAWAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5828
Mailing Address - Country:US
Mailing Address - Phone:516-825-1188
Mailing Address - Fax:516-825-0939
Practice Address - Street 1:240 ROCKAWAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5828
Practice Address - Country:US
Practice Address - Phone:516-825-1188
Practice Address - Fax:516-825-0939
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0212731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice