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General NPI Number Information
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NPI Number | 1003119900
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Entity Type | Organization
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Legal Business Name | LONG ISLAND CHIROPRACTIC AND SPORTS THERAPY, P.C.
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 279 BURNSIDE AVE
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City | LAWRENCE
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State | NY
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Zip | 11559-1112
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Country | US
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Telephone | 917-538-7293
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Fax |
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Provider Business Mailing Address
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Address Line | 6934 59TH DR
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City | MASPETH
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State | NY
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Zip | 11378-2918
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Country | US
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Telephone | 917-538-7293
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK MANDARINO
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Credential |
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Telephone | 917-538-7293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X006608-1
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License Number State | NY
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