Provider Demographics
NPI:1043478837
Name:PARITSKY, GLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:
Last Name:PARITSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-2031
Mailing Address - Country:US
Mailing Address - Phone:631-277-6677
Mailing Address - Fax:631-665-6468
Practice Address - Street 1:2221 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-2031
Practice Address - Country:US
Practice Address - Phone:631-277-6677
Practice Address - Fax:631-665-6468
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDU39277Medicare UPIN