Provider Demographics
NPI:1639102668
Name:CENTORE, JOSEPHINE M (DC)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:M
Last Name:CENTORE
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 1:2376 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1825
Mailing Address - Country:US
Mailing Address - Phone:516-679-0900
Mailing Address - Fax:516-783-6093
Practice Address - Street 1:2376 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:NORTH BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-1825
Practice Address - Country:US
Practice Address - Phone:516-679-0900
Practice Address - Fax:516-783-6093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0078671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51271Medicare UPIN
NYX91241Medicare PIN