Provider Demographics
NPI:1932714805
Name:VINNIKOV, EDWARD
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:VINNIKOV
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 1:6 CROSSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6785
Mailing Address - Country:US
Mailing Address - Phone:646-705-3506
Mailing Address - Fax:
Practice Address - Street 1:6 CROSSWOOD WAY
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-6785
Practice Address - Country:US
Practice Address - Phone:646-705-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00156700171100000X
CT2176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist