1871162032 NPI number — EASTERN HEALTHCARE CHIROPRACTIC AND ACUPUNCTURE SERVICES PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871162032 NPI number — EASTERN HEALTHCARE CHIROPRACTIC AND ACUPUNCTURE SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN HEALTHCARE CHIROPRACTIC AND ACUPUNCTURE SERVICES 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:
1871162032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 LEONARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSAPEQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11758-7920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-410-3640
Provider Business Mailing Address Fax Number:
212-208-4648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 E 49TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10017-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-288-2823
Provider Business Practice Location Address Fax Number:
212-208-4648
Provider Enumeration Date:
06/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FUSARO
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
212-288-2823

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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