Provider Demographics
NPI:1164019956
Name:REALIGN CHIROPRACTIC NY
Entity Type:Organization
Organization Name:REALIGN CHIROPRACTIC NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSTAKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-303-1303
Mailing Address - Street 1:496 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1944
Mailing Address - Country:US
Mailing Address - Phone:516-303-1303
Mailing Address - Fax:
Practice Address - Street 1:496 PLANDOME ROAD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:917-952-1778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty