Healthcare Provider Details

I. General information

NPI: 1366958159
Provider Name (Legal Business Name): FIDI CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2017
Last Update Date: 08/26/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BROADWAY STE 1535
NEW YORK NY
10004-1617
US

IV. Provider business mailing address

42 BROADWAY STE 1535
NEW YORK NY
10004-1617
US

V. Phone/Fax

Practice location:
  • Phone: 212-401-6923
  • Fax: 212-401-6923
Mailing address:
  • Phone: 212-401-6923
  • Fax: 212-401-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number011346
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARALAMPOS BILITSIS
Title or Position: OWNER
Credential: DC
Phone: 718-744-4137