Healthcare Provider Details

I. General information

NPI: 1902845977
Provider Name (Legal Business Name): STEVEN G GEANOPULOS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 W 181ST ST
NEW YORK NY
10033-4543
US

IV. Provider business mailing address

812 W 181ST ST
NEW YORK NY
10033-4543
US

V. Phone/Fax

Practice location:
  • Phone: 212-928-3300
  • Fax: 212-740-2005
Mailing address:
  • Phone: 212-928-3300
  • Fax: 212-740-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: