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General NPI Number Information
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NPI Number | 1467648675
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Entity Type | Organization
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Legal Business Name | PETER A CHIDICHIMO, PT,PC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 404 JERUSALEM AVE
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City | HICKSVILLE
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State | NY
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Zip | 11801-5504
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Country | US
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Telephone | 516-931-7060
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Fax | 516-933-3609
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Provider Business Mailing Address
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Address Line | 404 JERUSALEM AVE
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City | HICKSVILLE
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State | NY
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Zip | 11801-5504
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Country | US
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Telephone | 516-931-7060
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Fax | 516-933-3609
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER CHIDICHIMO
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Credential | PT
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Telephone | 516-931-7060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 006763
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License Number State | NY
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