Provider Demographics
NPI:1114079183
Name:MILFORD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MILFORD FAMILY CHIROPRACTIC LLC
Other - Org Name:CENTRAL PARK FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-707-8585
Mailing Address - Street 1:240 CENTRAL PARK S STE 2-0
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1452
Mailing Address - Country:US
Mailing Address - Phone:212-707-8585
Mailing Address - Fax:212-707-8123
Practice Address - Street 1:240 CENTRAL PARK S STE 2-0
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1452
Practice Address - Country:US
Practice Address - Phone:212-707-8585
Practice Address - Fax:212-707-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2013111N00000X
MD01700111N00000X
WACH00033732111N00000X
NY011513-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U75114Medicare UPIN
Y45244Medicare ID - Type Unspecified