NPIMap

Organization Active NPI

Roosevelt Family Chiropractic, PC

  • Chiropractor
  • Woodside, NY
National Provider Identifier
1760716583
Registry record updated Sep 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
XOO7887-1 Issued in NY
Legal business name
ROOSEVELT FAMILY CHIROPRACTIC, PC
Practice address
6317 Roosevelt Ave
Woodside, NY 11377-3641
Phone
(718) 335-7700
Fax
(718) 335-2254
NPI assigned
Sep 25, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2009

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

Authorized official

Name
Dr. Mehrzad Issac Kohansieh, DC
Title
Owner
Phone
(718) 335-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X XOO7887-1 NY Primary

Addresses

Primary practice location

6317 Roosevelt Ave
Woodside, NY 11377-3641

Mailing address

6317 Roosevelt Ave
Woodside, NY 11377-3641
Phone (718) 335-7700

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1760716583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6317 ROOSEVELT AVE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113773641",
            "telephone_number": "718-335-7700",
            "fax_number": "718-335-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6317 ROOSEVELT AVE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113773641",
            "telephone_number": "718-335-7700",
            "fax_number": "718-335-2254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOSEVELT FAMILY CHIROPRACTIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-25",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "KOHANSIEH",
        "authorized_official_first_name": "MEHRZAD",
        "authorized_official_middle_name": "ISSAC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-335-7700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "XOO7887-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; 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.