Provider Demographics
NPI:1003119900
Name:LONG ISLAND CHIROPRACTIC AND SPORTS THERAPY, P.C.
Entity Type:Organization
Organization Name:LONG ISLAND CHIROPRACTIC AND SPORTS THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-538-7293
Mailing Address - Street 1:6934 59TH DR
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2918
Mailing Address - Country:US
Mailing Address - Phone:917-538-7293
Mailing Address - Fax:
Practice Address - Street 1:279 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1112
Practice Address - Country:US
Practice Address - Phone:917-538-7293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006608-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty