Provider Demographics
NPI:1609188895
Name:IFSHIN, JESSICA M (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:IFSHIN
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BRIDGE ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3517
Mailing Address - Country:US
Mailing Address - Phone:619-253-5539
Mailing Address - Fax:
Practice Address - Street 1:30 BRIDGE ST
Practice Address - Street 2:UNIT 103
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3517
Practice Address - Country:US
Practice Address - Phone:619-253-5539
Practice Address - Fax:619-234-4624
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7514171100000X
CT000526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist