Provider Demographics
NPI:1740571314
Name:PESSIN, JACK
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:PESSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PONDVIEW ROAD
Mailing Address - Street 2:UNIT A
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580
Mailing Address - Country:US
Mailing Address - Phone:914-393-3560
Mailing Address - Fax:
Practice Address - Street 1:30 PONDVIEW ROAD
Practice Address - Street 2:UNIT A
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580
Practice Address - Country:US
Practice Address - Phone:914-393-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001442171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist