Healthcare Provider Details

I. General information

NPI: 1922376862
Provider Name (Legal Business Name): GLEN HEAD CHIROPRACTIC & PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 FOREST AVE STE A
GLEN COVE NY
11542-2068
US

IV. Provider business mailing address

189 FOREST AVE STE A
GLEN COVE NY
11542-2068
US

V. Phone/Fax

Practice location:
  • Phone: 516-759-2032
  • Fax: 516-759-2117
Mailing address:
  • Phone: 516-759-2032
  • Fax: 516-759-2117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FRANK COHEN
Title or Position: OWNER
Credential: DC
Phone: 516-759-2032