Provider Demographics
NPI:1104914191
Name:GURA, PHILIP STEVEN (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:STEVEN
Last Name:GURA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1530
Mailing Address - Country:US
Mailing Address - Phone:516-593-8333
Mailing Address - Fax:516-593-8344
Practice Address - Street 1:559 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1530
Practice Address - Country:US
Practice Address - Phone:516-593-8333
Practice Address - Fax:516-593-8344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005605-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00123334OtherPALMETTO GBA
P3204341OtherOXFORD HEALTH PLANS
NYX6F91OtherBLUE CROSS BLUESHIELD
NY808342OtherMANAGED PHYSICAL NETWORK
NY5897788OtherGHI
NYC05605-3OtherWORKERS COMPENSATION
NYX6F91OtherBLUE CROSS BLUESHIELD
P00123334OtherPALMETTO GBA