Healthcare Provider Details

I. General information

NPI: 1093420788
Provider Name (Legal Business Name): COMPREHENSIVE ACUPUNCTURE AND PHYSICAL THERAPY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 W 235TH ST SIDE ENTRANCE
BRONX NY
10463-1795
US

IV. Provider business mailing address

531 W 235TH ST SIDE ENTRANCE
BRONX NY
10463-1795
US

V. Phone/Fax

Practice location:
  • Phone: 718-432-1323
  • Fax: 718-432-1323
Mailing address:
  • Phone: 718-432-1323
  • Fax: 718-432-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER SHERMAN
Title or Position: PARTNER
Credential: PT
Phone: 718-432-1323