Provider Demographics
NPI:1982963385
Name:SHINNICK, PHILLIP KENT (ACUPUNCTURE)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:KENT
Last Name:SHINNICK
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1000
Mailing Address - Country:US
Mailing Address - Phone:212-426-3744
Mailing Address - Fax:212-945-6453
Practice Address - Street 1:1070 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1000
Practice Address - Country:US
Practice Address - Phone:212-426-3744
Practice Address - Fax:212-945-6453
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000931-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist