Provider Demographics
NPI:1780960971
Name:PINSKY, SHOSHANA (OD)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:PINSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:UNGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1161 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2243
Mailing Address - Country:US
Mailing Address - Phone:973-685-7280
Mailing Address - Fax:973-685-7281
Practice Address - Street 1:1161 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2243
Practice Address - Country:US
Practice Address - Phone:973-685-7280
Practice Address - Fax:973-685-7281
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA-00631800152W00000X
NJ27OM-00103600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ295018Medicare PIN