Healthcare Provider Details

I. General information

NPI: 1134928849
Provider Name (Legal Business Name): WEST ISLIP CHIROPRACTIC, PHYSICAL THERAPY, ACUPUNCTURE, AND ADULT HEALTH NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 MONTAUK HWY UPPR LEVEL
WEST ISLIP NY
11795-4926
US

IV. Provider business mailing address

786 MONTAUK HWY UPPR LEVEL
WEST ISLIP NY
11795-4926
US

V. Phone/Fax

Practice location:
  • Phone: 631-661-1400
  • Fax: 631-661-5242
Mailing address:
  • Phone: 631-661-1400
  • Fax: 631-661-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GERARD J SMITH
Title or Position: OWNER
Credential: DC
Phone: 631-661-1400