Provider Demographics
NPI:1386991743
Name:ALTMAN, YAACOV (DC)
Entity type:Individual
Prefix:DR
First Name:YAACOV
Middle Name:
Last Name:ALTMAN
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 1:6160 JERICHO TPKE
Mailing Address - Street 2:#6
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2802
Mailing Address - Country:US
Mailing Address - Phone:516-900-4325
Mailing Address - Fax:631-760-8321
Practice Address - Street 1:1410 BROADWAY
Practice Address - Street 2:CATALYST SPORT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5007
Practice Address - Country:US
Practice Address - Phone:516-900-4325
Practice Address - Fax:631-760-8321
Is Sole Proprietor?:No
Enumeration Date:2012-08-04
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor