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General NPI Number Information
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NPI Number | 1437962149
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Entity Type | Organization
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Legal Business Name | STATEN ISLAND CHIROPRACTIC & SPORTS REHAB P.C.
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 2950 HYLAN BLVD STE 100
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4056
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Country | US
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Telephone | 718-874-6002
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Fax | 718-874-6005
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Provider Business Mailing Address
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Address Line | 2950 HYLAN BLVD STE 100
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4056
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Country | US
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Telephone | 718-874-6002
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Fax | 718-874-6005
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Authorized Official
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Title or Position | CEO
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Name | DR. ROBERT MINLIONICA
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Credential | DC
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Telephone | 718-702-3659
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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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