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General NPI Number Information
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NPI Number | 1487832168
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Entity Type | Individual
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Provider Name | MARY T. GMITEREK D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 16 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2917
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Country | US
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Telephone | 516-944-3615
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Fax | 516-944-6001
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Provider Business Mailing Address
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Address Line | 16 MAIN ST
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-2917
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Country | US
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Telephone | 516-944-3615
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Fax | 516-944-6001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | X008528
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License Number State | NY
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