Healthcare Provider Details
I. General information
NPI: 1467864397
Provider Name (Legal Business Name): NEW WELLING PHYSICAL THERAPY AND ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
13235 41ST RD 1G
FLUSHING NY
11355-4113
US
IV. Provider business mailing address
13235 41ST RD 1G
FLUSHING NY
11355-4113
US
V. Phone/Fax
- Phone: 718-321-3600
- Fax:
- Phone: 718-321-3600
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 171100000X |
| Taxonomy | Acupuncturist |
| License Number | 002573 |
| License Number State | NY |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QP2000X |
| Taxonomy | Physical Therapy Clinic/Center |
| License Number | 037057 |
| License Number State | NY |
VIII. Authorized Official
Name: MR.
WILLIAM
SHENGLI
VU
Title or Position: MEMBER
Credential:
Phone: 917-922-8830