Provider Demographics
NPI:1225782618
Name:PAUL D PRIOLO DC PC
Entity Type:Organization
Organization Name:PAUL D PRIOLO DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PRIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-379-2711
Mailing Address - Street 1:4 CHAPEL HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-2470
Mailing Address - Country:US
Mailing Address - Phone:631-379-2711
Mailing Address - Fax:
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY STE 8
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7680
Practice Address - Country:US
Practice Address - Phone:631-676-6324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000000000OtherNOT IN MEDICARE OR MEDICADE