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General NPI Number Information
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NPI Number | 1114668084
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Entity Type | Organization
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Legal Business Name | COOPER SCIASCIA DC LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 1313 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4338
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Country | US
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Telephone | 718-448-0687
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Fax | 718-448-3463
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Provider Business Mailing Address
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Address Line | 1313 CLOVE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10301-4338
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Country | US
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Telephone | 718-448-0687
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Fax | 718-448-3463
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Authorized Official
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Title or Position | OWNER
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Name | DR. COOPER JOHN SCIASCIA
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Credential | D.C.
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Telephone | 908-577-7185
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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 |
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License Number State |
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