Healthcare Provider Details

I. General information

NPI: 1356566533
Provider Name (Legal Business Name): ROBERT C WULFORST L.AC, A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S BROADWAY
HICKSVILLE NY
11801
US

IV. Provider business mailing address

85 S BROADWAY
HICKSVILLE NY
11801
US

V. Phone/Fax

Practice location:
  • Phone: 516-610-0107
  • Fax: 270-596-0107
Mailing address:
  • Phone: 516-610-0107
  • Fax: 270-596-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002740
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: