Healthcare Provider Details

I. General information

NPI: 1710139365
Provider Name (Legal Business Name): THOMAS J. TESI, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 BROADWAY
NEW YORK NY
10033-3703
US

IV. Provider business mailing address

611 S MOUNTAIN RD
NEW CITY NY
10956-5706
US

V. Phone/Fax

Practice location:
  • Phone: 212-568-7403
  • Fax: 845-639-0625
Mailing address:
  • Phone: 845-642-1009
  • Fax: 845-639-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX004644
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS J. TESI
Title or Position: CHIROPRACTOR/PRESIDENT
Credential: M.S., D.C., P.C.
Phone: 845-642-1009