Provider Demographics
NPI:1316032253
Name:FRESH MEADOWS CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:FRESH MEADOWS CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-454-0737
Mailing Address - Street 1:184 17 UNION TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:718-454-0737
Mailing Address - Fax:718-454-1819
Practice Address - Street 1:184 17 UNION TURNPIKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:718-454-0737
Practice Address - Fax:718-454-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY65698Medicare PIN
T32055Medicare UPIN