Provider Demographics
NPI:1235403569
Name:GRAND CENTRAL CHIROPRACTICE & PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:GRAND CENTRAL CHIROPRACTICE & PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-953-6040
Mailing Address - Street 1:370 LEXINGTON AVE
Mailing Address - Street 2:SUITE 1212
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-953-6040
Mailing Address - Fax:212-953-0089
Practice Address - Street 1:370 LEXINGTON AVE
Practice Address - Street 2:SUITE 1212
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:212-953-6040
Practice Address - Fax:212-953-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003779111N00000X
NY027129225100000X
NY004780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty