Provider Demographics
NPI:1124329495
Name:JORGE RICARDO DELGADO, DC, PC.
Entity type:Organization
Organization Name:JORGE RICARDO DELGADO, DC, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:RICARDO
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-292-3455
Mailing Address - Street 1:111 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-4315
Mailing Address - Country:US
Mailing Address - Phone:845-292-3455
Mailing Address - Fax:845-295-0186
Practice Address - Street 1:111 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-4315
Practice Address - Country:US
Practice Address - Phone:845-292-3455
Practice Address - Fax:845-295-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04828111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX28041Medicare PIN
NYT53040Medicare UPIN