Provider Demographics
NPI:1508311135
Name:NEW YORK CORE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:NEW YORK CORE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-577-8933
Mailing Address - Street 1:20810 CROSS ISLAND PKWY # 528
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1187
Mailing Address - Country:US
Mailing Address - Phone:718-577-8933
Mailing Address - Fax:
Practice Address - Street 1:20935 NORTHERN BLVD STE 209A
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3134
Practice Address - Country:US
Practice Address - Phone:718-577-8933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012540-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300133973Medicare UPIN