Healthcare Provider Details

I. General information

NPI: 1780512251
Provider Name (Legal Business Name): SUKHMANJOT S VIRK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 OLD COUNTRY RD
WESTBURY NY
11590-5139
US

IV. Provider business mailing address

274 JACKSON AVE
SYOSSET NY
11791-4120
US

V. Phone/Fax

Practice location:
  • Phone: 718-877-9023
  • Fax:
Mailing address:
  • Phone: 718-877-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number014064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: