Provider Demographics
NPI:1265727978
Name:FOREST HILLS CHIROPRACTIC PC
Entity type:Organization
Organization Name:FOREST HILLS CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:RENEH
Authorized Official - Last Name:TRABULSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-624-2300
Mailing Address - Street 1:220 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3422
Mailing Address - Country:US
Mailing Address - Phone:212-624-2300
Mailing Address - Fax:212-624-2400
Practice Address - Street 1:220 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3422
Practice Address - Country:US
Practice Address - Phone:212-624-2300
Practice Address - Fax:212-624-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010871261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100045257Medicare PIN
NYA400045264Medicare PIN