Provider Demographics
NPI:1326280165
Name:PAUL M VASSA DC PC
Entity Type:Organization
Organization Name:PAUL M VASSA 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:M
Authorized Official - Last Name:VASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-368-4172
Mailing Address - Street 1:1187 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2632
Mailing Address - Country:US
Mailing Address - Phone:631-368-4172
Mailing Address - Fax:631-475-0399
Practice Address - Street 1:485 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1762
Practice Address - Country:US
Practice Address - Phone:631-475-0353
Practice Address - Fax:631-475-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty