Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 023320 | CT |
Y | 207N00000X | Dermatologist | 16806 | NH |
NPI | 1023089711 |
---|---|
Provider Name | Jeffrey K Shornick |
First Address | Lebanon, NH 03766-1937 |
Second Address | Lebanon, NH 03766-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001233204 | (05) | CT |
B83710 | (02) |