Healthcare Provider Details

I. General information

NPI: 1245500602
Provider Name (Legal Business Name): MAGENHEIM CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 RICHMOND AVE
STATEN ISLAND NY
10314-3914
US

IV. Provider business mailing address

1944 RICHMOND AVE
STATEN ISLAND NY
10314-3914
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-7500
  • Fax: 718-370-0850
Mailing address:
  • Phone: 718-370-7500
  • Fax: 718-370-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005442
License Number StateNY

VIII. Authorized Official

Name: DR. LEE MAGENHEIM
Title or Position: OWNER
Credential: DC
Phone: 718-370-7500