Healthcare Provider Details

I. General information

NPI: 1285839233
Provider Name (Legal Business Name): MARC JOHN LAMANTIA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BROADWAY 16TH FLOOR
NEW YORK NY
10038
US

IV. Provider business mailing address

160 BROADWAY 16TH FLOOR
NEW YORK NY
10038
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-7760
  • Fax: 212-360-7974
Mailing address:
  • Phone: 212-360-7760
  • Fax: 212-360-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberX008247-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: