Provider Demographics
NPI:1952470924
Name:METZ, SHIMON (DC)
Entity Type:Individual
Prefix:DR
First Name:SHIMON
Middle Name:
Last Name:METZ
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 1:222 ROCKAWAY TPKE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-1817
Mailing Address - Country:US
Mailing Address - Phone:516-509-0126
Mailing Address - Fax:516-706-1219
Practice Address - Street 1:222 ROCKAWAY TPKE
Practice Address - Street 2:SUITE ONE
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-1817
Practice Address - Country:US
Practice Address - Phone:516-509-0126
Practice Address - Fax:516-706-1219
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63103Medicare UPIN