Healthcare Provider Details

I. General information

NPI: 1275363319
Provider Name (Legal Business Name): BREAKTHRU ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14-25 PLAZA RD STE S22
FAIR LAWN NJ
07410-3591
US

IV. Provider business mailing address

99 HILLSIDE AVE APT 16I
NEW YORK NY
10040-2722
US

V. Phone/Fax

Practice location:
  • Phone: 917-439-8577
  • Fax:
Mailing address:
  • Phone: 917-439-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: LEV VYSHEDSKY
Title or Position: PRESIDENT
Credential: L. AC.
Phone: 917-439-8577