Provider Demographics
NPI:1982154258
Name:KIAEI, ASHLEY (DC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:KIAEI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SHORE PARK RD.
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:929-522-0914
Mailing Address - Fax:929-522-0914
Practice Address - Street 1:7020 YELLOWSTONE BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3500
Practice Address - Country:US
Practice Address - Phone:929-522-0914
Practice Address - Fax:929-522-0914
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012223-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor