Healthcare Provider Details

I. General information

NPI: 1336850684
Provider Name (Legal Business Name): NORTH SHORE FAMILY ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 VETERANS MEMORIAL HWY STE 1
COMMACK NY
11725-4331
US

IV. Provider business mailing address

354 VETERANS MEMORIAL HWY STE 1
COMMACK NY
11725-4331
US

V. Phone/Fax

Practice location:
  • Phone: 631-600-0306
  • Fax: 475-333-3062
Mailing address:
  • Phone: 631-600-0306
  • Fax: 475-333-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL BLOCK
Title or Position: OWNER
Credential: LAC, ND
Phone: 631-219-8671