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General NPI Number Information
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NPI Number | 1164019956
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Entity Type | Organization
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Legal Business Name | REALIGN CHIROPRACTIC NY
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 01/14/2024
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Provider Practice Location Address
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Address Line | 496 PLANDOME ROAD
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City | MANHASSET
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State | NY
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Zip | 11030
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Country | US
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Telephone | 917-952-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 496 PLANDOME RD
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City | MANHASSET
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State | NY
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Zip | 11030-1944
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Country | US
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Telephone | 516-303-1303
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY MOUSTAKAS
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Credential | DC
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Telephone | 516-303-1303
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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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