1053590521 NPI number — LI CHIRO AND REHAB PLLC

Table of content: (NPI 1053590521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053590521 NPI number — LI CHIRO AND REHAB PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LI CHIRO AND REHAB PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053590521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56A MOTOR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11735-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-752-1910
Provider Business Mailing Address Fax Number:
516-752-1914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-728-0612
Provider Business Practice Location Address Fax Number:
718-545-7771
Provider Enumeration Date:
10/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
V.
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
516-752-1910

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  00X2629 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)