Provider Demographics
NPI:1508676560
Name:IMMORDINO CAPITAL CORP
Entity type:Organization
Organization Name:IMMORDINO CAPITAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:IMMORDINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-683-8044
Mailing Address - Street 1:89 SUFFOLK LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1535
Mailing Address - Country:US
Mailing Address - Phone:631-210-6338
Mailing Address - Fax:
Practice Address - Street 1:4097 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6211
Practice Address - Country:US
Practice Address - Phone:631-683-8044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service