Provider Demographics
NPI:1962694885
Name:JACQUELINE DIMALANTE DC PC
Entity type:Organization
Organization Name:JACQUELINE DIMALANTE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMALANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-422-2225
Mailing Address - Street 1:720 UDALL ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-422-2225
Mailing Address - Fax:
Practice Address - Street 1:720 UDALL ROAD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-422-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty