NPIMap

Organization Active NPI

Optimal Chiropractic Associates, PLLC

  • Sports Physician Chiropractor
  • Sunnyside, NY
National Provider Identifier
1225203136
Registry record updated Dec 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
X008794 Issued in NY
Legal business name
OPTIMAL CHIROPRACTIC ASSOCIATES, PLLC
Practice address
4601 43Rd Ave
Sunnyside, NY 11104-1507
Phone
(718) 433-2399
Fax
(718) 433-0483
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2008

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

Authorized official

Name
Dr. Nicholas Charles Bavaro, DCNPI 1699862300
Title
Chiropractor
Phone
(718) 433-2399

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NS0005X X008794 NY Primary

Addresses

Primary practice location

4601 43Rd Ave
Sunnyside, NY 11104-1507

Mailing address

4601 43Rd Ave
Sunnyside, NY 11104-1507
Phone (718) 433-2399

Other identifiers 1

IdentifierTypeStateIssuer
02090540MedicaidNY

National Provider Directory

National Provider Directory

Locations

4601 43rd Ave
Sunnyside, NY 11104
Phone (718) 433-2379

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228780800000",
    "number": "1225203136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 43RD AVE",
            "city": "SUNNYSIDE",
            "state": "NY",
            "postal_code": "111041507",
            "telephone_number": "718-433-2399",
            "fax_number": "718-433-0483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 43RD AVE",
            "city": "SUNNYSIDE",
            "state": "NY",
            "postal_code": "111041507",
            "telephone_number": "718-433-2399",
            "fax_number": "718-433-0483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL CHIROPRACTIC ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-12-09",
        "status": "A",
        "authorized_official_last_name": "BAVARO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "718-433-2399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X008794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02090540",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunnyside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2008; 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.