Provider Demographics
NPI:1801869201
Name:SOLTANOFF, GREGORY J (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:SOLTANOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4470
Mailing Address - Country:US
Mailing Address - Phone:845-331-0300
Mailing Address - Fax:845-331-1130
Practice Address - Street 1:324 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4470
Practice Address - Country:US
Practice Address - Phone:845-331-0300
Practice Address - Fax:845-331-1130
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009137-0111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOD531Medicare ID - Type Unspecified