Provider Demographics
NPI:1689754061
Name:SAROLI, STEPHEN JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:SAROLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3101
Mailing Address - Country:US
Mailing Address - Phone:631-289-0088
Mailing Address - Fax:631-289-6177
Practice Address - Street 1:79 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3101
Practice Address - Country:US
Practice Address - Phone:631-289-0088
Practice Address - Fax:631-289-6177
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005861111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX64881Medicare PIN
NYU51512Medicare UPIN