Provider Demographics
NPI:1952573065
Name:NEW YORK CHIROPRACTIC & PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:NEW YORK CHIROPRACTIC & PHYSICAL THERAPY, PLLC
Other - Org Name:STATEN ISLAND CHIROPRACTIC ASSOCIATES, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PIAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-727-0055
Mailing Address - Street 1:1163 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2408
Mailing Address - Country:US
Mailing Address - Phone:718-727-0055
Mailing Address - Fax:718-727-3020
Practice Address - Street 1:1163 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2408
Practice Address - Country:US
Practice Address - Phone:718-727-0055
Practice Address - Fax:718-727-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52382Medicare UPIN