Healthcare Provider Details

I. General information

NPI: 1124427836
Provider Name (Legal Business Name): FORGET ME NOT ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 FULTON ST
BROOKLYN NY
11238-2346
US

IV. Provider business mailing address

973 FULTON ST
BROOKLYN NY
11238-2346
US

V. Phone/Fax

Practice location:
  • Phone: 347-741-1774
  • Fax:
Mailing address:
  • Phone: 347-741-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number004494
License Number StateNY

VIII. Authorized Official

Name: EDWARD GOUSSE
Title or Position: ACUPUNCTURIST
Credential:
Phone: 347-741-1774