Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jimmy Shak

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1285132530

Jimmy Shak is a Student in an Organized Health Care Education/Training Program in Old Bridge, New Jersey. Practices as a sole proprietor. Licensed in New Jersey.

Licensed in
NJ
In the registry since
2018
Specialties on file
2

Practice location Address checks out

2455 Route 516 Fl 1
Old Bridge, NJ 08857-1892
Phone: (646) 203-6960
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Dentistry (primary) Taxonomy 1223P0221X · Licence 22DI02796200 (NJ)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1285132530
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 31, 2018
Last updated in NPPESMay 17, 2021
Certification dateApril 27, 2021
Mailing address8 Floral Terrace, Tenafly, NJ 07670

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