Provider Demographics
NPI:1003564451
Name:MRNN CHIROPRACTIC & PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:MRNN CHIROPRACTIC & PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-705-5600
Mailing Address - Street 1:30 S OCEAN AVE RM 102
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3550
Mailing Address - Country:US
Mailing Address - Phone:516-705-5600
Mailing Address - Fax:
Practice Address - Street 1:30 S OCEAN AVE RM 102
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3550
Practice Address - Country:US
Practice Address - Phone:516-705-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty