Provider Demographics
NPI:1760554927
Name:GRIESNER, SHOSHANA (DC)
Entity Type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:
Last Name:GRIESNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 108 ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4323
Mailing Address - Country:US
Mailing Address - Phone:718-897-9243
Mailing Address - Fax:718-263-1410
Practice Address - Street 1:6960 108 ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4323
Practice Address - Country:US
Practice Address - Phone:718-897-9243
Practice Address - Fax:718-263-1410
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0034211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1G14128OtherOXFORD
NY0097321Medicare ID - Type UnspecifiedMEDICARE GHL
NYT32198Medicare UPIN