Provider Demographics
NPI:1730286378
Name:KANSAO, JOSEPH E (CH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:KANSAO
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1242
Mailing Address - Country:US
Mailing Address - Phone:212-360-6100
Mailing Address - Fax:212-360-7052
Practice Address - Street 1:1120 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1242
Practice Address - Country:US
Practice Address - Phone:212-360-6100
Practice Address - Fax:212-360-7052
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3881111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX22171Medicare PIN