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General NPI Number Information
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NPI Number | 1619257979
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Entity Type | Individual
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Provider Name | CYNTHIA M POLISTENA-WITMAN D.C.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 16 CRUMWOLD PL
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City | HYDE PARK
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State | NY
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Zip | 12538-1107
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Country | US
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Telephone | 914-466-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 16 CRUMWOLD PL
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City | HYDE PARK
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State | NY
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Zip | 12538-1107
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Country | US
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Telephone | 914-466-9696
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Fax |
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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 | X010695
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License Number State | NY
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