Provider Demographics
NPI:1255606877
Name:VASTOLA, LOUIS H (DC)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:H
Last Name:VASTOLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15637 100TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3238
Mailing Address - Country:US
Mailing Address - Phone:718-300-8957
Mailing Address - Fax:718-374-3203
Practice Address - Street 1:200 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1107
Practice Address - Country:US
Practice Address - Phone:718-300-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor