Provider Demographics
NPI:1750502894
Name:WATERFRONT CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:WATERFRONT CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ASLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-549-1490
Mailing Address - Street 1:146 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2150
Mailing Address - Country:US
Mailing Address - Phone:631-549-1749
Mailing Address - Fax:631-673-7249
Practice Address - Street 1:146 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2150
Practice Address - Country:US
Practice Address - Phone:631-549-1749
Practice Address - Fax:631-673-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1477622611OtherINDIVIDUAL NPI
NYX36811Medicare ID - Type UnspecifiedMEDICARE ID#