Provider Demographics
NPI:1417227133
Name:SELECT CHIROPRACTIC & PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SELECT CHIROPRACTIC & PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODOSIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAMONITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-428-3500
Mailing Address - Street 1:19413 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3032
Mailing Address - Country:US
Mailing Address - Phone:718-428-3500
Mailing Address - Fax:718-428-0800
Practice Address - Street 1:19413 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3032
Practice Address - Country:US
Practice Address - Phone:718-428-3500
Practice Address - Fax:718-428-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006238111N00000X
NY024817-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGOtherPENDING