=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952426215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANY RICHARD SUTERA D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 05/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 MAMARONECK AVE STE 100
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-761-1121
-----------------------------------------------------
Fax | 914-761-1132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 MAMARONECK AVE STE 100
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10605-1304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-761-1121
-----------------------------------------------------
Fax | 914-761-1132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X009823-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------