Provider Demographics
NPI:1285005827
Name:EA CHIROPRACTIC DIAGNOSTICS PC
Entity Type:Organization
Organization Name:EA CHIROPRACTIC DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMBUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-843-2661
Mailing Address - Street 1:2451 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2801
Mailing Address - Country:US
Mailing Address - Phone:718-239-3123
Mailing Address - Fax:718-822-1387
Practice Address - Street 1:2451 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2801
Practice Address - Country:US
Practice Address - Phone:718-239-3123
Practice Address - Fax:718-822-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0124901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty