Provider Demographics
NPI:1295416618
Name:NEW YORK INJURY CHIROPRACTIC REHAB PC
Entity type:Organization
Organization Name:NEW YORK INJURY CHIROPRACTIC REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC DOCTOR/AO
Authorized Official - Prefix:
Authorized Official - First Name:AVIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-622-9429
Mailing Address - Street 1:3723 72ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6126
Mailing Address - Country:US
Mailing Address - Phone:443-622-9429
Mailing Address - Fax:
Practice Address - Street 1:3723 72ND ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6126
Practice Address - Country:US
Practice Address - Phone:718-255-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty