Provider Demographics
NPI:1942741632
Name:EASTERN HEALTHCARE DC PC
Entity Type:Organization
Organization Name:EASTERN HEALTHCARE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FUSARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-557-7596
Mailing Address - Street 1:48 LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7920
Mailing Address - Country:US
Mailing Address - Phone:516-557-7596
Mailing Address - Fax:847-886-7525
Practice Address - Street 1:331 E 71ST ST
Practice Address - Street 2:STE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4733
Practice Address - Country:US
Practice Address - Phone:516-557-7596
Practice Address - Fax:847-886-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX033339111N00000X
NY022715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty