Healthcare Provider Details

I. General information

NPI: 1376776732
Provider Name (Legal Business Name): DESANO CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8416 JAMAICA AVE
WOODHAVEN NY
11421-1920
US

IV. Provider business mailing address

8416 JAMAICA AVE
WOODHAVEN NY
11421-1920
US

V. Phone/Fax

Practice location:
  • Phone: 718-296-6900
  • Fax: 718-296-0737
Mailing address:
  • Phone: 718-296-6900
  • Fax: 718-296-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6703330001
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX006997-1
License Number StateNY

VIII. Authorized Official

Name: DR. ANTHONY S. DESANO
Title or Position: OFFICER
Credential: D.C.
Phone: 718-296-6900