Provider Demographics
NPI:1114965365
Name:HASTAVA, THERESA MARIE (DC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:HASTAVA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARENTE LN N
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1065
Mailing Address - Country:US
Mailing Address - Phone:516-315-5518
Mailing Address - Fax:516-432-9035
Practice Address - Street 1:445 WESTBURY BLVD
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-1940
Practice Address - Country:US
Practice Address - Phone:516-683-3900
Practice Address - Fax:516-683-2184
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor