Provider Demographics
NPI:1962878454
Name:SUFFOLK CHIROPRACTIC REHABILITATION, P.C.
Entity type:Organization
Organization Name:SUFFOLK CHIROPRACTIC REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-772-7000
Mailing Address - Street 1:439 SUITE E WILLIAM FLOYD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-0000
Mailing Address - Country:US
Mailing Address - Phone:631-772-7000
Mailing Address - Fax:
Practice Address - Street 1:439 WILLIAM FLOYD PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-3466
Practice Address - Country:US
Practice Address - Phone:631-772-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3391111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty