Provider Demographics
NPI:1316278260
Name:OPTIMUM CHIROPRACTIC HEALTH PC
Entity type:Organization
Organization Name:OPTIMUM CHIROPRACTIC HEALTH PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOLDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-268-4464
Mailing Address - Street 1:147 MOTT ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5522
Mailing Address - Country:US
Mailing Address - Phone:516-992-2365
Mailing Address - Fax:516-766-1963
Practice Address - Street 1:7136 110TH ST
Practice Address - Street 2:SUITE SP1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4850
Practice Address - Country:US
Practice Address - Phone:718-268-4464
Practice Address - Fax:718-544-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU82174Medicare UPIN
NYG300000179Medicare PIN