# FULL STRIDE SPINE & SPORT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043842362
- **Authorized official:** STEVEN PUNGELLO (CHIROPRACTOR)
- **Authorized official phone:** (845) 238-9651

## Contact information

- **Practice address:** 150 KNICKERBOCKER AVE STE F, BOHEMIA, NY 11716-3163
- **Practice address phone:** (845) 238-9651
- **Mailing address:** 150 KNICKERBOCKER AVE STE F, BOHEMIA, NY 11716-3163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | — | Yes |

## Other

- **Enumeration date:** 02/05/2020
- **Last updated:** 02/05/2020