Provider Demographics
NPI:1235799883
Name:EAST MEADOW PT FAMILY HEALTH NP ACUPUNCTURE AND CHIROPRACTIC
Entity Type:Organization
Organization Name:EAST MEADOW PT FAMILY HEALTH NP ACUPUNCTURE AND CHIROPRACTIC
Other - Org Name:EAST MEADOW PTDC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TESORIERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-242-4500
Mailing Address - Street 1:2103 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1317
Mailing Address - Country:US
Mailing Address - Phone:631-242-4500
Mailing Address - Fax:
Practice Address - Street 1:2103 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1317
Practice Address - Country:US
Practice Address - Phone:631-242-4500
Practice Address - Fax:631-242-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty