1225188907 NPI number — TOTAL CARE CHIRO OF NY, P.C.

Table of content: (NPI 1225188907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225188907 NPI number — TOTAL CARE CHIRO OF NY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL CARE CHIRO OF NY, P.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:
1225188907
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:
200 STATE ROUTE 34 N
Provider Second Line Business Mailing Address:
PO BOX 28
Provider Business Mailing Address City Name:
COLTS NECK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07722-1234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-332-9280
Provider Business Mailing Address Fax Number:
732-332-0444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 STATE ROUTE 34 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTS NECK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07722-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-332-9280
Provider Business Practice Location Address Fax Number:
732-332-0444
Provider Enumeration Date:
01/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHALLONIS
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
732-332-9280

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X011159 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111N00000X , with the licence number: X007156-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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