Provider Demographics
NPI:1528349966
Name:HAJDUK, GREGORY VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VINCENT
Last Name:HAJDUK
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 1:54 ROWLAND ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1630
Mailing Address - Country:US
Mailing Address - Phone:631-523-7017
Mailing Address - Fax:
Practice Address - Street 1:54 ROWLAND ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1630
Practice Address - Country:US
Practice Address - Phone:631-523-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor