Healthcare Provider Details

I. General information

NPI: 1457541575
Provider Name (Legal Business Name): DR. PHI;IP M. EPSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DOROTHEA ST
PLAINVIEW NY
11803-6211
US

IV. Provider business mailing address

1 DOROTHEA ST
PLAINVIEW NY
11803-6211
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-1616
  • Fax: 516-932-1632
Mailing address:
  • Phone: 516-932-1616
  • Fax: 516-932-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006594
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. PHILIP MARC EPSTEIN
Title or Position: OWNER
Credential: D.C.
Phone: 516-932-1616