Provider Demographics
NPI:1912363185
Name:GARDEN CITY PT & CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GARDEN CITY PT & CHIROPRACTIC PLLC
Other - Org Name:GARDEN CITY PTDC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:J
Authorized Official - Last Name:TESORIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-242-4500
Mailing Address - Street 1:2103 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1317
Mailing Address - Country:US
Mailing Address - Phone:631-242-4500
Mailing Address - Fax:631-242-0885
Practice Address - Street 1:825 E GATE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2124
Practice Address - Country:US
Practice Address - Phone:631-242-4500
Practice Address - Fax:631-242-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004766111N00000X
NY030587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty