East End Sports Chiropractic, PC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

X010203-1 Issued in NY

Legal business name

EAST END SPORTS CHIROPRACTIC, PC

Practice address

39 Division St
Ground FLR, 2ND Offc From Rear
Sag Harbor, NY 11963-3156

Phone

(631) 725-8209

Fax

(631) 919-1592

NPI assigned

Oct 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stephen James Petruccelli, D.C.NPI 1710045208

Title

Chiropractor/Owner

Phone

(631) 725-8209

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen James Petruccelli, D.C.

  • Sports Physician Chiropractor
  • Sag Harbor, NY
  • NPI 1710045208
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1215280276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2902",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119630401",
            "telephone_number": "631-725-8209",
            "fax_number": "631-919-1592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 DIVISION ST",
            "address_2": "GROUND FLR, 2ND OFFC FROM REAR",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119633156",
            "telephone_number": "631-725-8209",
            "fax_number": "631-919-1592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST END SPORTS CHIROPRACTIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "PETRUCCELLI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CHIROPRACTOR/OWNER",
        "authorized_official_telephone_number": "631-725-8209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X010203-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Dolores Desesa, RN, CLT
• Deborah Disunno, OTA
• Kelly J Downes, DC
• Elise Rachel Duryea, M.A., CCC-SLP
• East End Counseling LCSW PLLC
• Stephanie Joanne Esposito, LMT, MLDC
• Essential Massage H & W, LLC
• Liliana Fazendeiro, PTA
• Emily Mara Feinberg, LMSW
• Fighting Chance, Inc

• Sports Physician Chiropractor in Sag Harbor, NY
• Providers in Sag Harbor, NY by specialty
• Sports Physician Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.