Healthcare Provider Details

I. General information

NPI: 1205340254
Provider Name (Legal Business Name): BED STUY ACUPUNCTURE AND MASSAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 BEDFORD AVE STOREFRONT
BROOKLYN NY
11216
US

IV. Provider business mailing address

1069 BEDFORD AVE STOREFRONT
BROOKLYN NY
11216-4793
US

V. Phone/Fax

Practice location:
  • Phone: 862-252-1230
  • Fax:
Mailing address:
  • Phone: 862-252-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003500
License Number StateNY

VIII. Authorized Official

Name: KATHERINE O'NEAL HENDERSON
Title or Position: OWNER, SENIOR ACUPUNCTURIST
Credential: LAC
Phone: 917-282-7208