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Jimmy Shak
Pediatric Dentist in Old Bridge, New Jersey
NPI 1285132530

Jimmy Shak is a Pediatric Dentist based in Tenafly, NJ and is specialized in Pediatric Dentistry. Jimmy Shak practices in Old Bridge, NJ. The NPI Number for Jimmy Shak is 1285132530 and holds a License No. (New Jersey).

The current practice location address for Jimmy Shak is 2455 Route 516 Fl 1, Old Bridge, NJ and can be reached out via phone at 646-203-6960.

Location: 2455 Route 516 Fl 1, Old Bridge, NJ, 07670
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1285132530
Provider Name
Jimmy Shak
Credential
Provider Entity Type
Individual
Gender
Male
Address
2455 Route 516 Fl 1, Old Bridge, NJ, 07670
Phone Number
646-203-6960
Fax Number
Provider Enumeration Date
01/31/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
2455 Route 516 Fl 1
City
Old Bridge
State
New Jersey
Zip
08857-1892
Phone Number
646-203-6960
Fax Number
person
Provider Business Mailing Address Details
Address
2455 Route 516 Fl 1
City
Old Bridge
State
New Jersey
Zip
08857-1892
Phone Number
646-203-6960
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
22DI02796200 (New Jersey)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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