Provider Demographics
NPI:1710109665
Name:CHIROPRACTIC ASSOCIATES OF LONG ISLAND PC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF LONG ISLAND PC
Other - Org Name:SMITHCONSET CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-724-1991
Mailing Address - Street 1:195 SMITHTOWN BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767
Mailing Address - Country:US
Mailing Address - Phone:631-724-1991
Mailing Address - Fax:631-724-1995
Practice Address - Street 1:195 SMITHTOWN BLVD
Practice Address - Street 2:STE 105
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767
Practice Address - Country:US
Practice Address - Phone:631-724-1991
Practice Address - Fax:631-724-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX0W111Medicare PIN