Provider Demographics
NPI:1962762591
Name:INTEGRATED CHIROPRACTIC AND PHYSICAL THERAPY ASSOCIATES PLLC
Entity type:Organization
Organization Name:INTEGRATED CHIROPRACTIC AND PHYSICAL THERAPY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-475-8104
Mailing Address - Street 1:10 E 21ST ST STE 1106
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7181
Mailing Address - Country:US
Mailing Address - Phone:212-475-8104
Mailing Address - Fax:212-475-4443
Practice Address - Street 1:10 E 21ST ST STE 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7181
Practice Address - Country:US
Practice Address - Phone:212-475-8104
Practice Address - Fax:212-475-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440113063225100000X
363LA2200X
NYX008846111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1083891741OtherCHIROPRACTOR
NY1730664897OtherPHYSICAL THERAPY
NY1740788504OtherNURSE PRACTITIONER
NY1295204923OtherPHYSICAL THERAPY