Provider Demographics
NPI:1720529027
Name:NORTH CARLL CHIROPRACTIC IMAGING, P.C.
Entity Type:Organization
Organization Name:NORTH CARLL CHIROPRACTIC IMAGING, P.C.
Other - Org Name:BABYLON DIAGNOSTIC IMAGING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:WINOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-482-8829
Mailing Address - Street 1:130 N CARLL AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2238
Mailing Address - Country:US
Mailing Address - Phone:631-482-8829
Mailing Address - Fax:631-482-8832
Practice Address - Street 1:130 N CARLL AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2238
Practice Address - Country:US
Practice Address - Phone:631-482-8829
Practice Address - Fax:631-482-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010061-2261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile