Healthcare Provider Details

I. General information

NPI: 1346955473
Provider Name (Legal Business Name): BEYOND SPORTS ACUPUNCTURE AND MASSAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 CAYUGA AVE
DEER PARK NY
11729-1624
US

IV. Provider business mailing address

203 CAYUGA AVE
DEER PARK NY
11729-1624
US

V. Phone/Fax

Practice location:
  • Phone: 631-481-6478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA GUTIERREZ
Title or Position: ACUPUNCTURIST
Credential:
Phone: 631-481-6478