Healthcare Provider Details

I. General information

NPI: 1750335386
Provider Name (Legal Business Name): HILLSIDE CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250-20 HILLSIDE AVENUE
BELLEROSE NY
11426-2149
US

IV. Provider business mailing address

250-20 HILLSIDE AVENUE
BELLEROSE NY
11426-2149
US

V. Phone/Fax

Practice location:
  • Phone: 718-343-0474
  • Fax: 718-962-2818
Mailing address:
  • Phone: 718-343-0474
  • Fax: 718-962-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0038381
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0035711
License Number StateNY

VIII. Authorized Official

Name: DR. PHILIP DP ABESSINIO
Title or Position: PRESIDENT
Credential: DC
Phone: 718-343-0474