Provider Demographics
NPI:1881381168
Name:MANDARINO CHIROPRACTIC
Entity type:Organization
Organization Name:MANDARINO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MANDARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-750-5111
Mailing Address - Street 1:436 ROUTE 79 STE 21
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-9797
Mailing Address - Country:US
Mailing Address - Phone:732-617-8000
Mailing Address - Fax:732-591-1000
Practice Address - Street 1:2052 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2583
Practice Address - Country:US
Practice Address - Phone:732-617-8000
Practice Address - Fax:732-891-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty