Provider Demographics
NPI:1629119060
Name:WINNICK, WAYNE M (DC)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:M
Last Name:WINNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E 74TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3249
Mailing Address - Country:US
Mailing Address - Phone:212-249-7790
Mailing Address - Fax:212-717-4519
Practice Address - Street 1:159 E 74TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3249
Practice Address - Country:US
Practice Address - Phone:212-249-7790
Practice Address - Fax:212-717-4519
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003030-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWW0X175310Medicare ID - Type Unspecified