Provider Demographics
NPI:1053449876
Name:GRANTIS, TOM ANASTASIS (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:ANASTASIS
Last Name:GRANTIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2837
Mailing Address - Country:US
Mailing Address - Phone:631-224-3036
Mailing Address - Fax:631-224-4764
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2837
Practice Address - Country:US
Practice Address - Phone:631-224-3036
Practice Address - Fax:631-224-4764
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012407-1111N00000X
NJ38MC00609500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081592SZWMedicare PIN