Healthcare Provider Details

I. General information

NPI: 1316571573
Provider Name (Legal Business Name): RIVERHEAD CHIROPRACTIC AND PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 OLD COUNTRY RD
RIVERHEAD NY
11901-2019
US

IV. Provider business mailing address

1081 OLD COUNTRY RD
RIVERHEAD NY
11901-2019
US

V. Phone/Fax

Practice location:
  • Phone: 516-520-5026
  • Fax:
Mailing address:
  • Phone: 516-520-5026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LORI-ANNE C ALBANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-996-0337