Healthcare Provider Details

I. General information

NPI: 1316032253
Provider Name (Legal Business Name): FRESH MEADOWS CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 17 UNION TURNPIKE
FRESH MEADOWS NY
11365
US

IV. Provider business mailing address

184 17 UNION TURNPIKE
FRESH MEADOWS NY
11365
US

V. Phone/Fax

Practice location:
  • Phone: 718-454-0737
  • Fax: 718-454-1819
Mailing address:
  • Phone: 718-454-0737
  • Fax: 718-454-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEROLD BLATT
Title or Position: PRES
Credential:
Phone: 718-454-0737