Provider Demographics
NPI:1467539478
Name:ROCKWOOD PARK CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:ROCKWOOD PARK CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FUGGETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-845-6600
Mailing Address - Street 1:9117 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2741
Mailing Address - Country:US
Mailing Address - Phone:718-845-6600
Mailing Address - Fax:718-738-1782
Practice Address - Street 1:9117 157TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2741
Practice Address - Country:US
Practice Address - Phone:718-845-6600
Practice Address - Fax:718-738-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009366-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY617429OtherUNITED HEALTHCARE
NY5898353OtherGHI
NYX0G810OtherBLUECROSS/BLUESHIELD
NYP2162430OtherOXFORD HEALTHCARE
NYU84109Medicare UPIN
NY617429OtherUNITED HEALTHCARE