| NPI | 1871147595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE BYRNES Billing/Credentialing Manager 631-543-0004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2019-07-31 |