1952457640 NPI number — COMPREHENSIVE CHIROPRACTIC & REHABILITATION, PC

Table of content: (NPI 1952457640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952457640 NPI number — COMPREHENSIVE CHIROPRACTIC & REHABILITATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE CHIROPRACTIC & REHABILITATION, PC
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:
1952457640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 VOORHIES AVE
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-3994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-332-5617
Provider Business Mailing Address Fax Number:
718-332-0448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 VOORHIES AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-3994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-5617
Provider Business Practice Location Address Fax Number:
718-332-0448
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURK
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
718-332-5617

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  01029-1 , 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: 1064550 . This is a "ASH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3006058 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5807446 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7982486 . This is a "AETNA NON HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X6N871 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3340904 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 640603 . This is a "ACN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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