Healthcare Provider Details

I. General information

NPI: 1538036173
Provider Name (Legal Business Name): PURE LIFE WELLNESS ACUPUNCTURE & PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 VETERANS MEMORIAL HWY
COMMACK NY
11725-3409
US

IV. Provider business mailing address

8 VETERANS MEMORIAL HWY
COMMACK NY
11725-3409
US

V. Phone/Fax

Practice location:
  • Phone: 631-352-2051
  • Fax: 631-983-4479
Mailing address:
  • Phone: 631-352-2051
  • Fax: 631-983-4479

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: DEAN K MONITTO
Title or Position: PARTNER
Credential: DACM, LAC.
Phone: 631-579-1888