Provider Demographics
NPI:1043485428
Name:SALVATORE R, PRINCIPE, DC, PC
Entity type:Organization
Organization Name:SALVATORE R, PRINCIPE, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRINCIPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-242-7555
Mailing Address - Street 1:420 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1322
Mailing Address - Country:US
Mailing Address - Phone:631-242-7555
Mailing Address - Fax:631-242-7587
Practice Address - Street 1:420 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1322
Practice Address - Country:US
Practice Address - Phone:631-242-7555
Practice Address - Fax:631-242-7587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4C191Medicare PIN