Serenity Source Chiropractic & Massage PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

007829 Issued in NY

Legal business name

SERENITY SOURCE CHIROPRACTIC & MASSAGE PLLC

Practice address

18 Weeks St Ste a
Blue Point, NY 11715-1513

Phone

(631) 404-7073

Fax

(631) 751-8298

NPI assigned

Jun 5, 2014

Organization subpart

No

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

Authorized official

Name

Miss Anthony Pusateri, DC

Title

Owner

Phone

(631) 404-7073

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Serenity Source Chiropractic Massage PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Serenity Source Physical Therapy, Chiropractic&Massage PLLC

  • Physical Medicine & Rehabilitation Physician
  • Blue Point, NY
  • NPI 1093117202
  NPD tax ID

Locations

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401926400000",
    "number": "1316350580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 WEEKS ST STE A",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151513",
            "telephone_number": "631-404-7073",
            "fax_number": "631-751-8298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 WEEKS ST STE A",
            "city": "BLUE POINT",
            "state": "NY",
            "postal_code": "117151513",
            "telephone_number": "631-404-7073",
            "fax_number": "631-751-8298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY SOURCE CHIROPRACTIC & MASSAGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2014-06-05",
        "status": "A",
        "authorized_official_last_name": "PUSATERI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-404-7073",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "007829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "007829",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick K Schipp, RN
• Molly Rae Sckalor, M.S. CF-SLP
• Polina Selnikova
• Adam Senese
• Serenity Source Chiropractic
• Serenity Source Massage Corp
• Serenity Source Physical Therapy, Chiropractic&Massage PLLC
• Corinne Patrice Serrian
• Emilyann Tyler Shergalis, RN
• Melba Laniece Shine, RN

• Chiropractor in Blue Point, NY
• Providers in Blue Point, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2014; 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.