Provider Demographics
NPI:1285969030
Name:FIALKOV, ROSS ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALAN
Last Name:FIALKOV
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 1:149 TWIN LN N
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1943
Mailing Address - Country:US
Mailing Address - Phone:516-658-3362
Mailing Address - Fax:516-595-1685
Practice Address - Street 1:213 SUMMIT RD STE 2L
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2316
Practice Address - Country:US
Practice Address - Phone:908-264-8116
Practice Address - Fax:888-908-8284
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012532111N00000X
NJ38MC00780100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00780100OtherLICENSE REGISTRATION
NYX012532OtherLICENSE