Healthcare Provider Details

I. General information

NPI: 1518388446
Provider Name (Legal Business Name): SYNERGY WELLNESS CHIROPRACTIC & PHYSICAL THERAPY, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E 14TH ST SUITE C
NEW YORK NY
10009-2700
US

IV. Provider business mailing address

237 1ST AVE FL 5
NEW YORK NY
10003-2919
US

V. Phone/Fax

Practice location:
  • Phone: 212-533-4900
  • Fax: 212-533-4931
Mailing address:
  • Phone: 212-533-4900
  • Fax: 212-533-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberX009893
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019761-1
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID KULLA
Title or Position: DIRECTOR
Credential: DC
Phone: 212-533-4900