Healthcare Provider Details

I. General information

NPI: 1003972852
Provider Name (Legal Business Name): CHRISTOPHER T FOGLIA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 SUNRISE HWY SUITE 200
BOHEMIA NY
11716-4611
US

IV. Provider business mailing address

PO BOX 708
SETAUKET NY
11733-0769
US

V. Phone/Fax

Practice location:
  • Phone: 631-750-9290
  • Fax: 631-750-9291
Mailing address:
  • Phone: 631-750-9290
  • Fax: 631-750-9291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberX007116
License Number StateNY

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: