=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063462927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIUS ANTHONY VARRICCHIO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 09/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10515 LIBERTY AVE
-----------------------------------------------------
City | OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11417-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-835-9600
-----------------------------------------------------
Fax | 718-835-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 STEWART AVE
-----------------------------------------------------
City | BETHPAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11714-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-622-6636
-----------------------------------------------------
Fax | 718-835-9601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X005018
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5808
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------