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General NPI Number Information
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NPI Number | 1578974077
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Entity Type | Organization
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Legal Business Name | ATLANTIC CHIROPRACTIC AND REHABILITATION P.C.
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 2088 FRONT ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-1709
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Country | US
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Telephone | 516-222-2455
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Fax | 516-222-2459
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Provider Business Mailing Address
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Address Line | 2088 FRONT ST
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City | EAST MEADOW
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State | NY
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Zip | 11554-1709
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Country | US
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Telephone | 516-222-2455
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Fax | 516-222-2459
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. GONZALO PATRICIO CORRIDORI
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Credential | D.C.
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Telephone | 516-222-2455
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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 | X011791-1
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License Number State | NY
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