Healthcare Provider Details

I. General information

NPI: 1114965365
Provider Name (Legal Business Name): THERESA MARIE HASTAVA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WESTBURY BLVD
HEMPSTEAD NY
11550-1940
US

IV. Provider business mailing address

15 PARENTE LN N
ISLAND PARK NY
11558-1065
US

V. Phone/Fax

Practice location:
  • Phone: 516-683-3900
  • Fax: 516-683-2184
Mailing address:
  • Phone: 516-315-5518
  • Fax: 516-432-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007717
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: