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General NPI Number Information
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NPI Number | 1881013910
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Entity Type | Organization
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Legal Business Name | AVANTAGE DIAGNOSTIC
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 734 FRANKLIN AVE SUITE 183
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City | GARDEN CITY
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State | NY
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Zip | 11530-4525
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Country | US
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Telephone | 973-747-9410
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Fax |
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Provider Business Mailing Address
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Address Line | 734 FRANKLIN AVE SUITE 183
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City | GARDEN CITY
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State | NY
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Zip | 11530-4525
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Country | US
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Telephone | 973-747-9410
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MONIQUE PASCUAL
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Credential | DC
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Telephone | 973-747-9410
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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 | 587393326
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License Number State | NY
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