Provider Demographics
NPI:1790449643
Name:CENTRAL SUFFOLK SPINE & SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:CENTRAL SUFFOLK SPINE & SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VISO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-617-5733
Mailing Address - Street 1:55 SECOND AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-617-5733
Mailing Address - Fax:631-617-5731
Practice Address - Street 1:55 SECOND AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-617-5733
Practice Address - Fax:631-617-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty