MEDICARE: NEW YORK CHIROPRACTIC & PHYSICAL THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1952573065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK CHIROPRACTIC & PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1163 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2408
Country	:	US
Telephone Number	:	718-727-0055
Fax Number	:	718-727-3020

Provider Business Practice Location Address
First Line	:	1163 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2408
Country	:	US
Telephone Number	:	718-727-0055
Fax Number	:	718-727-3020

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN P PIAZZA
Credential	:	DC
Telephone Number	:	718-727-0055

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	11/17/2014

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