MEDICARE: EAST MEETS WEST ACUPUNCTURE PLLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1952860645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST MEETS WEST ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	16 SQUADRON BLVD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5259
Country	:	US
Telephone Number	:	800-750-8616
Fax Number	:	845-362-8474

Provider Business Practice Location Address
First Line	:	16 SQUADRON BLVD
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5259
Country	:	US
Telephone Number	:	800-750-8616
Fax Number	:	845-362-8474

Authorized Official
Title or Position	:	OWNER
Name	:	GRACE MINELLA
Credential	:	LAC
Telephone Number	:	551-587-2287

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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