Provider Demographics
NPI:1023475266
Name:BACK TO BACK WELLNESS
Entity type:Organization
Organization Name:BACK TO BACK WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-496-6809
Mailing Address - Street 1:115 W 86TH ST
Mailing Address - Street 2:SUITE 1CC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3410
Mailing Address - Country:US
Mailing Address - Phone:212-496-6809
Mailing Address - Fax:212-496-6889
Practice Address - Street 1:115 W 86TH ST
Practice Address - Street 2:SUITE 1CC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3410
Practice Address - Country:US
Practice Address - Phone:212-496-6809
Practice Address - Fax:212-496-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002912111N00000X
NY004594171100000X
NJ2166111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN