Healthcare Provider Details

I. General information

NPI: 1689500480
Provider Name (Legal Business Name): LONG ISLAND SPINE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 BROADWAY STE 3
HEWLETT NY
11557-1630
US

IV. Provider business mailing address

1728 BROADWAY STE 3
HEWLETT NY
11557-1630
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-3339
  • Fax: 516-593-9473
Mailing address:
  • Phone:
  • Fax: 516-593-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM KORMAN
Title or Position: OWNER
Credential:
Phone: 516-668-7635