MEDICARE: GOOD LIFE ACUPUNCTURE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	003888	NY

General Provider Information

NPI Number	:	1053862417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD LIFE ACUPUNCTURE PC

Provider Business Mailing Address
First Line	:	175 MANORHAVEN BLVD
Second Line	:	UNIT D
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050
Country	:	US
Telephone Number	:	917-254-8340
Fax Number	:

Provider Business Practice Location Address
First Line	:	175D MANORHAVEN BLVD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1536
Country	:	US
Telephone Number	:	917-254-8340
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADINA DABIJA
Credential	:	L.AC.
Telephone Number	:	917-254-8340

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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Directions to “GOOD LIFE ACUPUNCTURE PC ” Practice Location

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