1528350600 NPI number — NATURAL CHIROPRACTIC CARE PC

Table of content: (NPI 1528350600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528350600 NPI number — NATURAL CHIROPRACTIC CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATURAL CHIROPRACTIC CARE 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:
1528350600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40693
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:
10304-0693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
862-324-5764
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 3RD AVE
Provider Second Line Business Practice Location Address:
C/O DR. SHARON RICH
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10455-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-585-0306
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICH
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-585-0306

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  700008734 , 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: 02011452 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: X0A412 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0571154 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: X0A411 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".