Provider Demographics
NPI:1740434620
Name:ATLANTIC PHYSICAL THERAPY & CHIROPRACTIC OF NEW YORK, PLLC
Entity type:Organization
Organization Name:ATLANTIC PHYSICAL THERAPY & CHIROPRACTIC OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-523-2878
Mailing Address - Street 1:305 LAURELTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3207
Mailing Address - Country:US
Mailing Address - Phone:516-670-0006
Mailing Address - Fax:516-670-0109
Practice Address - Street 1:305 LAURELTON BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3207
Practice Address - Country:US
Practice Address - Phone:516-670-0006
Practice Address - Fax:516-670-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010917-1111N00000X
NY62021858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty