1922376862 NPI number — GLEN HEAD CHIROPRACTIC & PHYSICAL THERAPY, PLLC

Table of content: (NPI 1922376862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922376862 NPI number — GLEN HEAD CHIROPRACTIC & PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLEN HEAD CHIROPRACTIC & PHYSICAL THERAPY, 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:
1922376862
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
189 FOREST AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN COVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11542-2068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-759-2032
Provider Business Mailing Address Fax Number:
516-759-2117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
189 FOREST AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN COVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11542-2068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-759-2032
Provider Business Practice Location Address Fax Number:
516-759-2117
Provider Enumeration Date:
12/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-759-2032

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053481168 . This is a "NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 320634 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P4467448 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1629152921 . This is a "1199 UNION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2416954 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2839005 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 320634 . This is a "MPN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q290L1 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0492010 . This is a "CIGNA / ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 535524 . This is a "UNITEDHEATLH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1629152921 . This is a "NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 320634 . This is a "THE EMPIRE PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4964083 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1002695 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1002695 . This is a "AMERICAN SPECIALTY HEATLH NETWORKS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P4449350 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1053481168 . This is a "1199 UNION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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