Provider Demographics
NPI:1033976147
Name:ISLAND CARE CHIROPRACTIC OF SUFFOLK PC
Entity Type:Organization
Organization Name:ISLAND CARE CHIROPRACTIC OF SUFFOLK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEETS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-993-5400
Mailing Address - Street 1:100 W SUFFOLK AVE UNIT G
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2155
Mailing Address - Country:US
Mailing Address - Phone:631-993-5400
Mailing Address - Fax:631-203-4468
Practice Address - Street 1:100 W SUFFOLK AVE UNIT G
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-2155
Practice Address - Country:US
Practice Address - Phone:631-388-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16999954396OtherNPI
NY1184807968OtherNPI