Healthcare Provider Details

I. General information

NPI: 1821364951
Provider Name (Legal Business Name): ZAS SPINAL CHIROPRACTIC CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SOUTH OCEAN AVE.
PATCHOGUE NY
11772
US

IV. Provider business mailing address

87 SOUTH OCEAN AVE.
PATCHOGUE NY
11772-3702
US

V. Phone/Fax

Practice location:
  • Phone: 631-569-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberX010484-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. AYAZ ALTAFF SHAH
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 631-569-5335