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Organization
PATCHOGUE-MEDFORD PT & CHIROPRACTIC PLLC
Active
Organization
PATCHOGUE-MEDFORD PT & CHIROPRACTIC PLLC
Active
Other names
Patchogue-Medford PTDC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK TESORIERO DC (MANAGING MEMBER)
(631) 617-5040
Entity
Organization
Contact information
Practice address
105 MEDFORD AVE, PATCHOGUE, NY 11772-1223
(631) 617-5040
(631) 617-5559
Mailing address
2103 DEER PARK AVE, DEER PARK, NY 11729-1317
(631) 242-4500
(631) 242-0885
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
004766
NY
225100000X
Physical Therapist
Primary
025310
NY
Other
Enumeration date
10/22/2015
Last updated
01/06/2016
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