Healthcare Provider Details

I. General information

NPI: 1740434620
Provider Name (Legal Business Name): ATLANTIC PHYSICAL THERAPY & CHIROPRACTIC OF NEW YORK, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 LAURELTON BLVD
LONG BEACH NY
11561-3207
US

IV. Provider business mailing address

305 LAURELTON BLVD
LONG BEACH NY
11561-3207
US

V. Phone/Fax

Practice location:
  • Phone: 516-670-0006
  • Fax: 516-670-0109
Mailing address:
  • Phone: 516-670-0006
  • Fax: 516-670-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010917-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62021858
License Number StateNY

VIII. Authorized Official

Name: DR. LOUIS CAMPBELL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 914-523-2878