Healthcare Provider Details

I. General information

NPI: 1730286378
Provider Name (Legal Business Name): JOSEPH E KANSAO CH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 PARK AVE
NEW YORK NY
10128-1242
US

IV. Provider business mailing address

1120 PARK AVE
NEW YORK NY
10128-1242
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-6100
  • Fax: 212-360-7052
Mailing address:
  • Phone: 212-360-6100
  • Fax: 212-360-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX3881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: