Healthcare Provider Details

I. General information

NPI: 1891742870
Provider Name (Legal Business Name): SALVATORE R PRINCIPE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 OLD COUNTRY RD
DEER PARK NY
11729-1322
US

IV. Provider business mailing address

420 OLD COUNTRY RD
DEER PARK NY
11729-1322
US

V. Phone/Fax

Practice location:
  • Phone: 631-242-7555
  • Fax: 631-242-7587
Mailing address:
  • Phone: 631-242-7555
  • Fax: 631-242-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX4382
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: