Healthcare Provider Details

I. General information

NPI: 1790855468
Provider Name (Legal Business Name): ANDREAS SKOUNAKIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 CLIFTON AVE STE 1F
CLIFTON NJ
07013-3518
US

IV. Provider business mailing address

1011 CLIFTON AVE STE 1F
CLIFTON NJ
07013-3518
US

V. Phone/Fax

Practice location:
  • Phone: 973-779-2466
  • Fax: 973-779-4943
Mailing address:
  • Phone: 973-779-2466
  • Fax: 973-779-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC006118
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00611800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: