Provider Demographics
NPI:1528168556
Name:BILA-CASSIDY, STACY (DC)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:BILA-CASSIDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RIVERLEIGH PL
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3503
Mailing Address - Country:US
Mailing Address - Phone:631-598-0654
Mailing Address - Fax:
Practice Address - Street 1:938 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2938
Practice Address - Country:US
Practice Address - Phone:516-358-0500
Practice Address - Fax:516-358-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007405-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU64957Medicare UPIN
NYX85621Medicare ID - Type Unspecified