1679767107 NPI number — O'CONNOR SPORTS & SPINE CHIROPRACTIC P.L.L.C.

Table of content: (NPI 1679767107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679767107 NPI number — O'CONNOR SPORTS & SPINE CHIROPRACTIC P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'CONNOR SPORTS & SPINE CHIROPRACTIC P.L.L.C.
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:
1679767107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1274 RICHMOND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10314-7450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-370-0074
Provider Business Mailing Address Fax Number:
718-948-1065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1274 RICHMOND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314-7450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-370-0074
Provider Business Practice Location Address Fax Number:
718-948-1065
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
O'CONNOR
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-370-0074

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  X010462 , 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)

  • Identifier: 1048657 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11303 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C10462-2 B . This is a "WORKERS COMPENSATION BOAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5897528 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 837410 . This is a "MPN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02882039 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 884228 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 662954 . This is a "ACN GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OCO462 . This is a "ATLANTIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3175411 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1048657 . This is a "ASHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P-12039392 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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