Healthcare Provider Details

I. General information

NPI: 1609165422
Provider Name (Legal Business Name): TOTAL HEALTH ACUPUNCTURE & MASSAGE THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 4TH AVE
BAY SHORE NY
11706-7900
US

IV. Provider business mailing address

156 4TH AVE
BAY SHORE NY
11706-7900
US

V. Phone/Fax

Practice location:
  • Phone: 631-647-7194
  • Fax: 631-647-7196
Mailing address:
  • Phone: 631-647-7194
  • Fax: 631-647-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002948
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number014918
License Number StateNY

VIII. Authorized Official

Name: MS. LIKUN LEE
Title or Position: PRESIDENT
Credential: L.AC., L.M.T.
Phone: 516-690-0027