Provider Demographics
NPI:1427194448
Name:VENTRESCA, CHARLES MICHAEL (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:VENTRESCA
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1832
Mailing Address - Country:US
Mailing Address - Phone:516-676-4267
Mailing Address - Fax:516-676-6811
Practice Address - Street 1:194 BIRCH HILL RD
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1832
Practice Address - Country:US
Practice Address - Phone:516-676-4267
Practice Address - Fax:516-676-6811
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4493111N00000X
NY000627171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4493Medicare ID - Type UnspecifiedMEDICARE NON-PAR #