Provider Demographics
NPI:1891812095
Name:ISLAND REHABILITATION CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ISLAND REHABILITATION CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-750-9290
Mailing Address - Street 1:6 OLD FIELD WOODS RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1618
Mailing Address - Country:US
Mailing Address - Phone:631-750-9290
Mailing Address - Fax:631-750-9291
Practice Address - Street 1:4875 SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-4611
Practice Address - Country:US
Practice Address - Phone:631-750-9290
Practice Address - Fax:631-750-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007116111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty