Healthcare Provider Details

I. General information

NPI: 1417177676
Provider Name (Legal Business Name): PLAZA CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63-32 99TH ST
REGO PARK NY
11374-1941
US

IV. Provider business mailing address

6332 99TH ST
REGO PARK NY
11374-1941
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-4141
  • Fax: 718-275-1805
Mailing address:
  • Phone: 718-275-4141
  • Fax: 718-275-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILIO WALDEMAR PAEZ
Title or Position: DIRECTOR
Credential: D.C.
Phone: 718-275-4141