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General NPI Number Information
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NPI Number | 1720529027
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Entity Type | Organization
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Legal Business Name | NORTH CARLL CHIROPRACTIC IMAGING, P.C.
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 130 N CARLL AVE
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City | BABYLON
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State | NY
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Zip | 11702-2238
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Country | US
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Telephone | 631-482-8829
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Fax | 631-482-8832
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Provider Business Mailing Address
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Address Line | 130 N CARLL AVE
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City | BABYLON
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State | NY
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Zip | 11702-2238
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Country | US
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Telephone | 631-482-8829
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Fax | 631-482-8832
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW TODD WINOKUR
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Credential | D.C.
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Telephone | 631-482-8829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | X010061-2
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License Number State | NY
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