Healthcare Provider Details

I. General information

NPI: 1285553198
Provider Name (Legal Business Name): MORDECHAI WILSHINSKY HEALTH COACH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 ELLSWORTH AVE
NEW HAVEN CT
06511-2820
US

IV. Provider business mailing address

495 ELLSWORTH AVE
NEW HAVEN CT
06511-2820
US

V. Phone/Fax

Practice location:
  • Phone: 917-755-5646
  • Fax:
Mailing address:
  • Phone: 917-755-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: