Provider Demographics
NPI:1104314483
Name:BREFNI CHIROPRACTIC DIAGNOSTICS P.C.
Entity type:Organization
Organization Name:BREFNI CHIROPRACTIC DIAGNOSTICS P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:FISHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-896-7138
Mailing Address - Street 1:25 BREFNI ST APT 57B
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1469
Mailing Address - Country:US
Mailing Address - Phone:631-896-7138
Mailing Address - Fax:516-568-0876
Practice Address - Street 1:125 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3822
Practice Address - Country:US
Practice Address - Phone:516-568-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003856-1111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty