Healthcare Provider Details

I. General information

NPI: 1073660999
Provider Name (Legal Business Name): GEORGE EMANUEL LOGOTHETIS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

68 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-1500
  • Fax: 201-489-1516
Mailing address:
  • Phone: 201-489-1500
  • Fax: 201-489-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMC04873
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: