Provider Demographics
NPI:1225298292
Name:NEW YORK CHIROPRACTIC ASSOCIATES
Entity Type:Organization
Organization Name:NEW YORK CHIROPRACTIC ASSOCIATES
Other - Org Name:PARK EAST CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-249-6767
Mailing Address - Street 1:1020 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0913
Mailing Address - Country:US
Mailing Address - Phone:212-249-6767
Mailing Address - Fax:212-861-4769
Practice Address - Street 1:1020 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0913
Practice Address - Country:US
Practice Address - Phone:212-249-6767
Practice Address - Fax:212-861-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX18411Medicare PIN