Healthcare Provider Details

I. General information

NPI: 1184761793
Provider Name (Legal Business Name): VILLAMAR CHIROPRACTIC AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BROADWAY BLDG 6TH FLOOR STE 300
NEW YORK NY
10038-4201
US

IV. Provider business mailing address

160 BROADWAY BLDG 6TH FLOOR STE 300
NEW YORK NY
10038-4201
US

V. Phone/Fax

Practice location:
  • Phone: 212-227-3350
  • Fax: 212-227-3379
Mailing address:
  • Phone: 212-227-3350
  • Fax: 212-227-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5946
License Number StateNY

VIII. Authorized Official

Name: MICHAEL MARGOILES
Title or Position: PRESIDENT
Credential: PT
Phone: 212-227-3350