MEDICARE: DR. SHOSHANA GRIESNER DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X0034211	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P1G14128	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1760554927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHOSHANA GRIESNER DC

Provider Business Mailing Address
First Line	:	6960 108 ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4323
Country	:	US
Telephone Number	:	718-897-9243
Fax Number	:	718-263-1410

Provider Business Practice Location Address
First Line	:	6960 108 ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4323
Country	:	US
Telephone Number	:	718-897-9243
Fax Number	:	718-263-1410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. SHOSHANA GRIESNER DC” Practice Location

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