Provider Demographics
NPI:1598192486
Name:MAXIMUS DIAGNOSTICS NADINE BEACH DC PC
Entity Type:Organization
Organization Name:MAXIMUS DIAGNOSTICS NADINE BEACH DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-422-6675
Mailing Address - Street 1:972 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-6110
Mailing Address - Country:US
Mailing Address - Phone:631-422-6675
Mailing Address - Fax:631-422-6718
Practice Address - Street 1:972 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6110
Practice Address - Country:US
Practice Address - Phone:631-422-6675
Practice Address - Fax:631-422-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010939-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty