Healthcare Provider Details

I. General information

NPI: 1114364874
Provider Name (Legal Business Name): WILSEY SQ. ACUPUNCTURE AND MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 PASCACK RD STE 4
TOWNSHIP OF WASHINGTON NJ
07676-4841
US

IV. Provider business mailing address

285 PASCACK RD STE 4
TOWNSHIP OF WASHINGTON NJ
07676-4841
US

V. Phone/Fax

Practice location:
  • Phone: 201-788-0294
  • Fax: 201-664-1485
Mailing address:
  • Phone: 201-788-0294
  • Fax: 201-664-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00064600
License Number StateNJ

VIII. Authorized Official

Name: MR. MICHAEL J. O'NEILL
Title or Position: OWNER
Credential: L.AC.
Phone: 201-788-0394