Healthcare Provider Details

I. General information

NPI: 1669470647
Provider Name (Legal Business Name): DR. STEVEN J.N. CHIERCHIE
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44210 MIDDLE ROAD, RTE. 48
SOUTHOLD NY
11971
US

IV. Provider business mailing address

PO BOX 400
SOUTHOLD NY
11971-0400
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-5151
  • Fax: 631-765-1162
Mailing address:
  • Phone: 631-765-5151
  • Fax: 631-765-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003972-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: