Provider Demographics
NPI:1932878055
Name:RIVERSIDE CHIROPRACTIC OF NY PC
Entity Type:Organization
Organization Name:RIVERSIDE CHIROPRACTIC OF NY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-648-1779
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-0833
Mailing Address - Country:US
Mailing Address - Phone:917-648-1779
Mailing Address - Fax:
Practice Address - Street 1:695 DUTCHESS TPKE STE 103
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6443
Practice Address - Country:US
Practice Address - Phone:845-493-1080
Practice Address - Fax:855-347-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1669022117OtherMICHAEL YOUNAN