Provider Demographics
NPI:1609172196
Name:DELTA WAVES NY
Entity Type:Organization
Organization Name:DELTA WAVES NY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWID
Authorized Official - Middle Name:
Authorized Official - Last Name:RECHUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-944-8328
Mailing Address - Street 1:752 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3900
Mailing Address - Country:US
Mailing Address - Phone:631-944-8328
Mailing Address - Fax:
Practice Address - Street 1:752 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3900
Practice Address - Country:US
Practice Address - Phone:631-944-8328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty