Healthcare Provider Details

I. General information

NPI: 1235799883
Provider Name (Legal Business Name): EAST MEADOW PT FAMILY HEALTH NP ACUPUNCTURE AND CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 03/30/2020
Certification Date: 03/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 DEER PARK AVE
DEER PARK NY
11729-1317
US

IV. Provider business mailing address

2103 DEER PARK AVE
DEER PARK NY
11729-1317
US

V. Phone/Fax

Practice location:
  • Phone: 631-242-4500
  • Fax: 631-242-0885
Mailing address:
  • Phone: 631-242-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACK JAMES TESORIERO
Title or Position: OWNER
Credential:
Phone: 631-242-4500