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General NPI Number Information
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NPI Number | 1699862300
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Entity Type | Individual
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Provider Name | NICHOLAS CHARLES BAVARO D.C.
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 422C GREAT EAST NECK RD UNIT C
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City | WEST BABYLON
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State | NY
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Zip | 11704-7610
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Country | US
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Telephone | 917-748-1139
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Fax |
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Provider Business Mailing Address
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Address Line | 422 GREAT EAST NECK RD UNIT C
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City | WEST BABYLON
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State | NY
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Zip | 11704-7628
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Country | US
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Telephone | 631-661-6611
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Fax | 631-661-5504
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | X008794
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License Number State | NY
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