Jack James Tesoriero, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

X004766 Issued in NY

Practice address

2103 Deer Park Ave
Deer Park, NY 11729-1319

Phone

(631) 242-4500

Fax

(631) 242-0885

NPI assigned

Sep 30, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wyandanch PT, Family Health NP and Chiropractic PLLC

  • Physical Therapist
  • Wyandanch, NY
  • NPI 1003454448

  Chiropractor

  NPD Authorized official
• West Islip PT & Chiropractic PLLC

  • Physical Therapist
  • Babylon, NY
  • NPI 1710414636

  Chiropractor

  NPD (past) Authorized official

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1871580282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291319",
            "telephone_number": "631-242-4500",
            "fax_number": "631-242-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291319",
            "telephone_number": "631-242-4500",
            "fax_number": "631-242-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESORIERO",
        "first_name": "JACK",
        "middle_name": "JAMES",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X004766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scheena Tannis, FNP
• Danielle Renee Tarantola
• Paul Tchao, MD
• Annette Nana Tehn-Addy, R.N.
• Susan Marie Terrone, CCC-SLP
• Ashley Paige Teta, M.S., PA-C
• Mildred Echevarria Thaw, RDH
• The Dees PT Inc
• The Institute for the Development of Children & Families
• The Stop & Shop Supermarket Company LLC

• Chiropractor in Deer Park, NY
• Providers in Deer Park, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.