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General NPI Number Information
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NPI Number | 1235614132
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Entity Type | Organization
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Legal Business Name | EAST MEADOW PT & CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 2120 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1803
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Country | US
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Telephone | 516-794-0414
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Fax | 516-794-0435
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Provider Business Mailing Address
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Address Line | 2120 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1803
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Country | US
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Telephone | 516-794-0414
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Fax | 516-794-0435
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Authorized Official
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Title or Position | OWNER
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Name | JACK TESORIERO
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Credential | DC
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Telephone | 631-680-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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