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General NPI Number Information
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NPI Number | 1710516554
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Entity Type | Organization
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Legal Business Name | TOVA DIAGNOSTIC CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 707 MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11024-1935
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Country | US
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Telephone | 516-466-2585
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Fax |
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Provider Business Mailing Address
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Address Line | 707 MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11024-1935
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING ASSOCIATE
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Name | DEREK MERCER
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Credential |
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Telephone | 718-841-7318
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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 |
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License Number State |
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