Provider Demographics
NPI:1336635671
Name:BROOKLYN SPINE AND JOINT CHIROPRACTIC PHYSICAL THERAPY REHAB AND ACUPU
Entity Type:Organization
Organization Name:BROOKLYN SPINE AND JOINT CHIROPRACTIC PHYSICAL THERAPY REHAB AND ACUPU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-533-6180
Mailing Address - Street 1:2019 NOSTRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210
Mailing Address - Country:US
Mailing Address - Phone:347-533-6180
Mailing Address - Fax:347-533-6177
Practice Address - Street 1:2019 NOSTRAND AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210
Practice Address - Country:US
Practice Address - Phone:347-533-6180
Practice Address - Fax:347-533-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4486111N00000X
NYX4638111N00000X
NY001575171100000X
NY032642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty